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Lowering of BP can increase risk of death in patients with CKD
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Acute declines in renal function during intense lowering of blood pressure can not only hasten the kidney’s demise but is also associated with a higher risk of patient mortality in some cases, a study shows.
Elaine Ku, MD, from the division of nephrology in the department of medicine at the University of California, San Francisco, and colleagues previously showed in studies that acute declines in renal function greater than or equal to 20% during intensive BP lowering were associated with a higher risk of ESRD.
“Here, we determined whether acute declines in renal function during intensive BP lowering were associated with mortality risk” among 1,660 participants in the African-American Study of Kidney Disease and Hypertension and the Modification of Diet in Renal Disease Trial.
Specifically, researchers looked at the impact of eGFR decline at several intervals (< 5%, 5% to 20% or 20%) at months 3 to 4 of the trial and tracked the mortality of those patients who had normal BP vs. those who experienced intensive lowering of BP.
“There is a paucity of data on whether the magnitude of decline in kidney function that occurs during intensive BP lowering is associated with long-term mortality risk in patients with CKD,” the authors wrote in explaining the research.
Study results found that, among participants previously assigned to intensive BP lowering, acute declines in kidney function up to 20% were associated with a better survival benefit compared to the usual BP arm. However, participants assigned to intensive BP lowering who showed declines in kidney function of 20% or greater had a higher risk of death.
“The data support intensive BP control when declines in kidney function are of moderate magnitude during the intensification of antihypertensive therapy. However, caution may be warranted when greater declines in kidney function occur during intensive BP lowering among patients with preexisting CKD,” the authors wrote.
Disclosure s : The research in the paper was supported by the NIH grant K23 HL131023 and K24 DK 110427. The authors report no relevant financial disclosures.
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