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Intensive SBP Lowering & Kidney, CV Outcomes

Ann Intern Med; ePub 2017 Sep 5; Beddhu, et al

Publish date:

Intensive systolic blood pressure (SBP) lowering increased the risk for incident chronic kidney disease (CKD) events in persons without kidney disease; however, this was offset by cardiovascular and all-cause mortality benefits. This according to a secondary analysis of the Systolic Blood Pressure Intervention Trial (SPRINT) that included 6,662 adults with high blood pressure and elevated CV risk. Participants had a baseline estimated glomerular filtration rate (eGFR) of at least 60 mL/min/1.73 m2 and were randomized to an intensive or standard SBP goal (120 or 140 mmHg, respectively). Researchers found:

  • The difference in adjusted mean eGFR between the groups was -3.32 mL/min/1.73m2 at 6 months, -4.50 mL/min/1.73m2 at 18 months, and remained relatively stable thereafter.
  • 3.7% of participants in the intensive group had an incident CKD event compared to 1.0% in the standard group at 3-year follow-up (HR, 3.54).
  • Corresponding percentages for the composite of death or CV events were 4.9% and 7.1% at 3-year follow-up (HR, 0.71).

Citation:

Beddhu S, Rocco MV, Toto R, et al. Effects of intensive systolic blood pressure control on kidney and cardiovascular outcomes in persons without kidney disease: A secondary analysis of a randomized trial. [Published online ahead of print September 5, 2017]. Ann Intern Med. doi:10.7326/M16-2966.

Commentary:

This secondary analysis of the SPRINT trial focuses on the development of CKD as well as cardiovascular outcomes in patients with GFRs above 60 mL/min/1.73 m2. There was an almost 4-fold increase in the development of CKD in the treated group, but a decrease of almost 30% in the composite of death or CV events. Much has been written about the difference in how the SPRINT trial was carried out compared to how most other trials were done, and to how blood pressure is assessed in the office. At this point, I believe it is best to await the next set of national guidelines before changing blood pressure goals for our patients. —Neil Skolnik, MD

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