An article published ahead of print by the Journal of the American Society of Nephrology reports that intensive blood pressure lowering reduces chronic kidney disease patients’ risks of dying prematurely or developing cardiovascular disease.
Noting that the appropriate target for blood pressure in patients with CKD and hypertension was never clear, a study team led by University of Utah used information from the Systolic Blood Pressure Intervention Trial (SPRINT), sponsored by the National Institutes of Health, to look for some answers.
SPRINT enrolled individuals aged 50 years or older with systolic blood pressure of 130 mmHg or higher and at least one additional cardiovascular disease risk factor; compared targeting a systolic blood pressure to less than120mm Hg versus less than 140 mmHg for preventing cardiovascular complications and early death. Almost a year before the planned end of the study, benefits of the lower target were apparent to investigator. The recent report was based on a subgroup analysis, with the composite cardiovascular outcome including heart attack, acute coronary syndrome, acute decompensated heart failure, stroke, or heart-related death.
Results indicate that patients diagnosed with CKD at the start of the study accrued similar benefits to those without CKD. In fact, after a median follow-up of 3.3 years for 1,330 CKD patients in the intensive group and 1,316 in the standard group, the composite cardiovascular outcome occurred in 112 and 131 participants—a 19% reduction in risk for intensive-group participants.
Study authors also point out that the intensive group had 70 deaths from any cause, compared to 95 in the standard group, which indicated a 28% reduction in risk. Age did not appear to be a factor, with participants 75 and older in the CKD group showing as much benefit as the younger cohort.
Researchers caution that the intensive group participants had a slightly faster decline in kidney function, but that no increase in kidney events such as kidney failure or serious adverse events were documented.
“Thus, among patients with CKD and hypertension without diabetes, targeting an SBP<120 mm Hg compared with <140 mmHg 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,” study authors conclude.
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