BP Control and Long-Term Risk of ESRD and Mortality

• Published in: Journal of the American Society of Nephrology Vol. 28; no. 2; pp. 671 - 677
• Main Authors: Ku, Elaine, Gassman, Jennifer, Appel, Lawrence J, Smogorzewski, Miroslaw, Sarnak, Mark J, Glidden, David V, Bakris, George, Gutiérrez, Orlando M, Hebert, Lee A, Ix, Joachim H, Lea, Janice, Lipkowitz, Michael S, Norris, Keith, Ploth, David, Pogue, Velvie A, Rostand, Stephen G, Siew, Edward D, Sika, Mohammed, Tisher, C Craig, Toto, Robert, Wright, Jr, Jackson T, Wyatt, Christina, Hsu, Chi-Yuan
• Format: Journal Article
• Language: English
• Published: United States American Society of Nephrology 01.02.2017
• Subjects: Clinical Research; Female; Humans; Hypertension - complications; Hypertension - prevention & control; Kidney Failure, Chronic - epidemiology; Kidney Failure, Chronic - etiology; Kidney Failure, Chronic - mortality; Male; Middle Aged; Risk Factors; Time Factors; ESRD; ckd; hypertension
• ISSN: 1046-6673; 1533-3450
• DOI: 10.1681/asn.2016030326

We recently showed an association between strict BP control and lower mortality risk during two decades of follow-up of prior participants in the Modification of Diet in Renal Disease (MDRD) trial. Here, we determined the risk of ESRD and mortality during extended follow-up of the African American Study of Kidney Disease and Hypertension (AASK) trial. We linked 1067 former AASK participants with CKD previously randomized to strict or usual BP control (mean arterial pressure ≤92 mmHg or 102-107 mmHg, respectively) to the US Renal Data System and Social Security Death Index; 397 patients had ESRD and 475 deaths occurred during a median follow-up of 14.4 years from 1995 to 2012. Compared with the usual BP arm, the strict BP arm had unadjusted and adjusted relative risks of ESRD of 0.92 (95% confidence interval [95% CI], 0.75 to 1.12) and 0.95 (95% CI, 0.78 to 1.16; P=0.64), respectively, and unadjusted and adjusted relative risks of death of 0.92 (95% CI, 0.77 to 1.10) and 0.81 (95% CI, 0.68 to 0.98; P=0.03), respectively. In meta-analyses of individual-level data from the MDRD and the AASK trials, unadjusted relative risk of ESRD was 0.88 (95% CI, 0.78 to 1.00) and unadjusted relative risk of death was 0.87 (95% CI, 0.76 to 0.99) for strict versus usual BP arms. Our findings suggest that, during long-term follow-up, strict BP control does not delay the onset of ESRD but may reduce the relative risk of death in CKD.