Determinants of progression in early autosomal dominant polycystic kidney disease: Is it blood pressure or renin-angiotensin-aldosterone-system blockade?

HALT PKD Investigators

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: The HALT PKD trial in early autosomal dominant polycystic kidney disease (ADPKD) showed that intensive control of systolic blood pressure to 95-110 mmHg was associated with a 14% slower rate of kidney volume growth compared to standard control. It is unclear whether this result was due to greater blockade of the renin-angiotensin-aldosterone system (RAAS) by allowing the use of higher drug doses in the low blood pressure arm, or due to the lower blood pressure per se. Methods: In this secondary analysis of HALT PKD Study A, we categorized participants into high and low dose groups based on the median daily equivalent dose of RAAS blocking drugs used after the initial dose titration period. Using linear mixed models, we compared the percent change in total kidney volume and the slope of estimated glomerular filtration rate (eGFR) between the 2 groups. We also assessed the effects of time-varying dose and time-varying blood pressure parameters on these outcomes. Results: Subjects in the high dose group (n=252) did not experience a slower increase in total kidney volume than those in the low-dose (n=225) group, after adjustment for age, sex, genotype, and BP arm. The chronic slope of eGFR decline was similar in the 2 groups. Higher time-varying systolic blood pressure was associated with a steeper decline in eGFR. Conclusion: ADPKD progression (as detected by eGFR decline and TKV increase) was ameliorated by intense blood pressure control as opposed to pharmacologic intensity of RAAS blockade.

Original languageEnglish (US)
Pages (from-to)39-47
Number of pages9
JournalCurrent Hypertension Reviews
Volume14
Issue number1
DOIs
StatePublished - Jan 1 2018

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Autosomal Dominant Polycystic Kidney
Renin-Angiotensin System
Blood Pressure
Glomerular Filtration Rate
Kidney
Pharmaceutical Preparations
Hypotension
Disease Progression
Linear Models
Genotype
Growth

Keywords

  • Angiotensin receptor blockers
  • Angiotensin-converting enzyme inhibitors
  • Autosomal dominant polycystic kidney disease
  • Estimated glomerular filtration rate
  • HALT PKD trials
  • Total kidney volume

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Determinants of progression in early autosomal dominant polycystic kidney disease : Is it blood pressure or renin-angiotensin-aldosterone-system blockade? / HALT PKD Investigators.

In: Current Hypertension Reviews, Vol. 14, No. 1, 01.01.2018, p. 39-47.

Research output: Contribution to journalArticle

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abstract = "Background: The HALT PKD trial in early autosomal dominant polycystic kidney disease (ADPKD) showed that intensive control of systolic blood pressure to 95-110 mmHg was associated with a 14{\%} slower rate of kidney volume growth compared to standard control. It is unclear whether this result was due to greater blockade of the renin-angiotensin-aldosterone system (RAAS) by allowing the use of higher drug doses in the low blood pressure arm, or due to the lower blood pressure per se. Methods: In this secondary analysis of HALT PKD Study A, we categorized participants into high and low dose groups based on the median daily equivalent dose of RAAS blocking drugs used after the initial dose titration period. Using linear mixed models, we compared the percent change in total kidney volume and the slope of estimated glomerular filtration rate (eGFR) between the 2 groups. We also assessed the effects of time-varying dose and time-varying blood pressure parameters on these outcomes. Results: Subjects in the high dose group (n=252) did not experience a slower increase in total kidney volume than those in the low-dose (n=225) group, after adjustment for age, sex, genotype, and BP arm. The chronic slope of eGFR decline was similar in the 2 groups. Higher time-varying systolic blood pressure was associated with a steeper decline in eGFR. Conclusion: ADPKD progression (as detected by eGFR decline and TKV increase) was ameliorated by intense blood pressure control as opposed to pharmacologic intensity of RAAS blockade.",
keywords = "Angiotensin receptor blockers, Angiotensin-converting enzyme inhibitors, Autosomal dominant polycystic kidney disease, Estimated glomerular filtration rate, HALT PKD trials, Total kidney volume",
author = "{HALT PKD Investigators} and Brosnahan, {Godela M.} and Abebe, {Kaleab Z.} and Moore, {Charity G.} and Bae, {Kyongtae T.} and Braun, {William E.} and Chapman, {Arlene B.} and Flessner, {Michael F.} and Harris, {Peter C} and Hogan, {Marie C} and Perrone, {Ronald D.} and Rahbari-Oskoui, {Frederic F.} and Steinman, {Theodore I.} and Vicente Torres",
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T2 - Is it blood pressure or renin-angiotensin-aldosterone-system blockade?

AU - HALT PKD Investigators

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AU - Abebe, Kaleab Z.

AU - Moore, Charity G.

AU - Bae, Kyongtae T.

AU - Braun, William E.

AU - Chapman, Arlene B.

AU - Flessner, Michael F.

AU - Harris, Peter C

AU - Hogan, Marie C

AU - Perrone, Ronald D.

AU - Rahbari-Oskoui, Frederic F.

AU - Steinman, Theodore I.

AU - Torres, Vicente

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N2 - Background: The HALT PKD trial in early autosomal dominant polycystic kidney disease (ADPKD) showed that intensive control of systolic blood pressure to 95-110 mmHg was associated with a 14% slower rate of kidney volume growth compared to standard control. It is unclear whether this result was due to greater blockade of the renin-angiotensin-aldosterone system (RAAS) by allowing the use of higher drug doses in the low blood pressure arm, or due to the lower blood pressure per se. Methods: In this secondary analysis of HALT PKD Study A, we categorized participants into high and low dose groups based on the median daily equivalent dose of RAAS blocking drugs used after the initial dose titration period. Using linear mixed models, we compared the percent change in total kidney volume and the slope of estimated glomerular filtration rate (eGFR) between the 2 groups. We also assessed the effects of time-varying dose and time-varying blood pressure parameters on these outcomes. Results: Subjects in the high dose group (n=252) did not experience a slower increase in total kidney volume than those in the low-dose (n=225) group, after adjustment for age, sex, genotype, and BP arm. The chronic slope of eGFR decline was similar in the 2 groups. Higher time-varying systolic blood pressure was associated with a steeper decline in eGFR. Conclusion: ADPKD progression (as detected by eGFR decline and TKV increase) was ameliorated by intense blood pressure control as opposed to pharmacologic intensity of RAAS blockade.

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KW - Estimated glomerular filtration rate

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KW - Total kidney volume

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