Effects of intensive BP control in CKD

Alfred K. Cheung, Mahboob Rahman, David M. Reboussin, Timothy E. Craven, Tom Greene, Paul L. Kimmel, William C. Cushman, Amret T. Hawfield, Karen C. Johnson, Cora E. Lewis, Suzanne Oparil, Michael V. Rocco, Kaycee M. Sink, Paul K. Whelton, Jackson T. Wright, Jan Basile, Srinivasan Beddhu, Udayan Bhatt, Tara I. Chang, Glenn M. ChertowMichel Chonchol, Barry I. Freedman, William Haley, Joachim H. Ix, Lois A. Katz, Anthony A. Killeen, Vasilios Papademetriou, Ana C. Ricardo, Karen Servilla, Barry Wall, Dawn Wolfgram, Jerry Yee

Research output: Contribution to journalArticlepeer-review

135 Scopus citations

Abstract

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; n=1330) or ,140 mm Hg (standard group; n=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 participantswith andwithoutCKD (P 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 (20.47 versus 20.32 ml/min per 1.73 m2 per year; P,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 CKDand hypertensionwithout diabetes, targeting an SBP,120mmHg comparedwith,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.

Original languageEnglish (US)
Pages (from-to)2812-2823
Number of pages12
JournalJournal of the American Society of Nephrology
Volume28
Issue number9
DOIs
StatePublished - Sep 2017

Bibliographical note

Funding Information:
The Systolic Blood Pressure Intervention Trial (SPRINT) was funded by the National Institutes of Health (including the National Heart, Lung, and Blood Institute; the National Institute of Diabetes and Digestive and Kidney Diseases; the National Institute on Aging; and the National Institute of Neurological Disorders and Stroke).

Funding Information:
A.K.C. is a consultant for Boehringer Ingelheim and a contributor to Up-to-Date. T.G. is a consultant for Jansen Pharmaceuticals, Pfizer Inc., and Sanofi. W.C.C. received an institutional grant from Eli Lilly and Co. and is an unpaid consultant of Takeda Pharmaceuticals. S.O. has received fees from Actelion Clinical Research, Inc.; AstraZeneca Pharmaceuticals; Boehringer Ingelheim; GlaxoSmithKline; Lilly; Lundbeck; Novo Nordisk, Inc.; and Onyx Pharma, Inc. and research grants from AstraZeneca; Bayer Healthcare Pharmaceuticals, Inc.; Merck and Co.; and Novartis, all outside of this submitted work. J.B. receives research support from Eli Lilly and Co. and is a consultant for Novartis and Medtronic, a contributor to Up-to-Date, and in a speaker bureau of Amgen, Arbor, and Janssen. B.I.F. receives research support from Novartis Pharmaceuticals and is a consultant for AstraZeneca Pharmaceuticals and Ionis Pharmaceuticals. M.R., D.M.R., T.E.C., P.L.K., A.T.H., K.C.J., C.E.L., M.V.R., K.M.

Publisher Copyright:
Copyright © 2017 by the American Society of Nephrology.

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