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 language | English (US) |
|---|---|
| Pages (from-to) | 2812-2823 |
| Number of pages | 12 |
| Journal | Journal of the American Society of Nephrology |
| Volume | 28 |
| Issue number | 9 |
| DOIs | |
| State | Published - Sep 1 2017 |
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ASJC Scopus subject areas
- Nephrology
Cite this
Effects of intensive BP control in CKD. / 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, Jackson T.; Basile, Jan; Beddhu, Srinivasan; Bhatt, Udayan; Chang, Tara I.; Chertow, Glenn M.; Chonchol, Michel; Freedman, Barry I.; Haley, William E; Ix, Joachim H.; Katz, Lois A.; Killeen, Anthony A.; Papademetriou, Vasilios; Ricardo, Ana C.; Servilla, Karen; Wall, Barry; Wolfgram, Dawn; Yee, Jerry.
In: Journal of the American Society of Nephrology, Vol. 28, No. 9, 01.09.2017, p. 2812-2823.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Effects of intensive BP control in CKD
AU - Cheung, Alfred K.
AU - Rahman, Mahboob
AU - Reboussin, David M.
AU - Craven, Timothy E.
AU - Greene, Tom
AU - Kimmel, Paul L.
AU - Cushman, William C.
AU - Hawfield, Amret T.
AU - Johnson, Karen C.
AU - Lewis, Cora E.
AU - Oparil, Suzanne
AU - Rocco, Michael V.
AU - Sink, Kaycee M.
AU - Whelton, Paul K.
AU - Wright, Jackson T.
AU - Basile, Jan
AU - Beddhu, Srinivasan
AU - Bhatt, Udayan
AU - Chang, Tara I.
AU - Chertow, Glenn M.
AU - Chonchol, Michel
AU - Freedman, Barry I.
AU - Haley, William E
AU - Ix, Joachim H.
AU - Katz, Lois A.
AU - Killeen, Anthony A.
AU - Papademetriou, Vasilios
AU - Ricardo, Ana C.
AU - Servilla, Karen
AU - Wall, Barry
AU - Wolfgram, Dawn
AU - Yee, Jerry
PY - 2017/9/1
Y1 - 2017/9/1
N2 - 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.
AB - 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.
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UR - http://www.scopus.com/inward/citedby.url?scp=85028735022&partnerID=8YFLogxK
U2 - 10.1681/ASN.2017020148
DO - 10.1681/ASN.2017020148
M3 - Article
VL - 28
SP - 2812
EP - 2823
JO - Journal of the American Society of Nephrology : JASN
JF - Journal of the American Society of Nephrology : JASN
SN - 1046-6673
IS - 9
ER -