Effects of Intensive BP Control in CKD

• Published in: Journal of the American Society of Nephrology Vol. 28; no. 9; pp. 2812 - 2823
• Main Authors: Cheung, Alfred K, Rahman, Mahboob, Reboussin, David M, Craven, Timothy E, Greene, Tom, Kimmel, Paul L, Cushman, William C, Hawfield, Amret T, Johnson, Karen C, Lewis, Cora E, Oparil, Suzanne, Rocco, Michael V, Sink, Kaycee M, Whelton, Paul K, Wright, Jr, Jackson T, Basile, Jan, Beddhu, Srinivasan, Bhatt, Udayan, Chang, Tara I, Chertow, Glenn M, Chonchol, Michel, Freedman, Barry I, Haley, William, Ix, Joachim H, Katz, Lois A, Killeen, Anthony A, Papademetriou, Vasilios, Ricardo, Ana C, Servilla, Karen, Wall, Barry, Wolfgram, Dawn, Yee, Jerry
• Format: Journal Article
• Language: English
• Published: United States American Society of Nephrology 01.09.2017
• Subjects: Acute Coronary Syndrome - epidemiology; Aged; Aged, 80 and over; Antihypertensive Agents - therapeutic use; Blood Pressure; Cause of Death; Clinical Research; Female; Follow-Up Studies; Glomerular Filtration Rate; Heart Failure - epidemiology; Humans; Hypertension - complications; Hypertension - drug therapy; Hypertension - physiopathology; Kidney Failure, Chronic - physiopathology; Male; Middle Aged; Myocardial Infarction - epidemiology; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - physiopathology; Stroke - epidemiology; Systole; mortality; blood pressure; cardiovascular disease; chronic kidney disease; glomerular filtration rate; hypertension
• ISSN: 1046-6673; 1533-3450
• DOI: 10.1681/asn.2017020148

The appropriate target for BP in patients with CKD and hypertension remains uncertain. We report prespecified subgroup analyses of outcomes in participants with baseline CKD in the Systolic Blood Pressure Intervention Trial. We randomly assigned participants to a systolic BP target of <120 mm Hg (intensive group; =1330) or <140 mm Hg (standard group; =1316). After a median follow-up of 3.3 years, the primary composite cardiovascular outcome occurred in 112 intensive group and 131 standard group CKD participants (hazard ratio [HR], 0.81; 95% confidence interval [95% CI], 0.63 to 1.05). The intensive group also had a lower rate of all-cause death (HR, 0.72; 95% CI, 0.53 to 0.99). Treatment effects did not differ between participants with and without CKD ( values for interactions ≥0.30). The prespecified main kidney outcome, defined as the composite of ≥50% decrease in eGFR from baseline or ESRD, occurred in 15 intensive group and 16 standard group participants (HR, 0.90; 95% CI, 0.44 to 1.83). After the initial 6 months, the intensive group had a slightly higher rate of change in eGFR (-0.47 versus -0.32 ml/min per 1.73 m per year; <0.03). The overall rate of serious adverse events did not differ between treatment groups, although some specific adverse events occurred more often in the intensive group. Thus, among patients with CKD and hypertension without diabetes, targeting an SBP<120 mm Hg compared with <140 mm Hg reduced rates of major cardiovascular events and all-cause death without evidence of effect modifications by CKD or deleterious effect on the main kidney outcome.