Is Intense BP Control Safe for Patients with CKD and Hypertension?
Intense blood pressure control in patients with hypertension and chronic kidney disease (CKD) is associated with reduced rates of cardiovascular events and all-cause death without affecting kidney function, according to results from a recent trial.
Appropriate blood pressure targets for patients with CKD and hypertension are not well defined, according to the researchers. In order to further investigate this issue, researchers randomly assigned participants from the Systolic Blood Pressure Intervention Trial to either a systolic blood pressure target of less than 120 mm Hg (intensive group; n=1330) or less than 140 mm Hg (standard group; n=1316).
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After a median follow-up of 3.3 years, the risk of major cardiovascular events was 19% lower in patients in the intense group compared with those in the standard group, and rates of all-cause mortality were 28% lower in the intense group than the standard group.
The main kidney outcome— the composite of ≥50% decrease in eGFR from baseline or end-stage renal failure—occurred in 15 patients in the intense group and 16 patients in the standard group, and the overall rate of serious adverse events did not differ between the groups.
“[A]mong patients with CKD and hypertension without diabetes, targeting an SBP<120 mm Hg compared with <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,” the researchers concluded.
—Michael Potts
Reference:
Cheung AK, Rahman M, Reboussin DM, et al. Effects of intensive BP control in CKD [published online June 22, 2017]. ASN. doi: 10.1681/ASN.2017020148.