Effects of Intensive Systolic Blood Pressure Control on Kidney and Cardiovascular Outcomes in Persons Without Kidney Disease

Abstract

National Institutes of Health.

Estimated glomerular filtration rate and the risk–benefit profile of intensive blood pressure control amongst nondiabetic patients: a post hoc analysis of a randomized clinical trial

“…The overall effect of intensive BP control on incident albuminuria was significant. However, the intervention did not prevent eGFR decline amongst participants with CKD but decreased eGFR amongst those without CKD, which is consistent with a recently reported secondary analysis of the SPRINT [28]. These apparently conflicting effects in the non-CKD group may be attributed to the acute effect of BP lowering and the greater use of reninangiotensin system inhibitors in the intensive treatment arm; [29,30] even a small negative acute effect (i.e.…”

Estimating the Association of the 2017 and 2014 Hypertension Guidelines With Cardiovascular Events and Deaths in US Adults

“…4 The Systolic Blood Pressure Intervention Trial (SPRINT) documented that an intensive SBP treatment target of <120 mmHg was associated with significant reductions of 25% for major CVD and 27% for all-cause mortality in individuals at high risk for CVD. 5-7 A recent meta-analysis of BP-lowering trials also demonstrated significant and linear associations between mean achieved SBP and the risk of CVD and all-cause mortality, with the lowest risks in randomization groups with mean achieved SBP of 120-124 mmHg. 8 …”

Intensive Blood Pressure Targets and Kidney Disease

“…In the SPRINT participants without baseline CKD, the difference in eGFR between randomized groups stabilized after month 18 at 4.5 ml/min per 1.73 m 2 (2). Of the 140 participants who developed incident CKD in the intensive group, 25% had improved eGFR in follow-up and no longer met the definition of incident CKD; none developed ESKD during the 3.3 median years of follow-up.…”

“…Among the SPRINT participants without baseline CKD, intensive BP lowering resulted in a 3.5-fold higher rate of incident CKD defined as a $30% reduction to ,60 ml/min per 1.73 m 2 (2). Like SPRINT, the Action to Control Cardiovascular Risk in Diabetes BP (ACCORD BP) Trial tested the effect of systolic BP target ,120 versus ,140 mm Hg on cardiovascular outcomes but in patients with type 2 diabetes mellitus (3).…”