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Benefits from intensive systolic BP control may outweigh CKD risks

The potential for intensive systolic BP lowering to reduce the composite of cardiovascular events or all-cause mortality outweighed its increased risk for incident chronic kidney disease events, according to findings published in Annals of Internal Medicine.

“About 1.3 billion adults worldwide are believed to have hypertension ... High blood pressure is one of the most important risk factors for cardiovascular disease (CVD) events, end-stage renal disease (ESRD), and all-cause death,” Srinivasan Beddhu, MD, from the University of Utah School of Medicine, and colleagues wrote.

“The public health significance of the reported higher incidence of chronic kidney disease (CKD) with intensive systolic blood pressure lowering is unclear,” the researchers added.

Beddhu and colleagues performed subgroup analyses of the SPRINT trial to evaluate how intensive systolic BP control (target <120 mm Hg) affects kidney and CV outcomes compared with standard control (target <140 mm Hg). They enrolled 6,662 adults with high BP, elevated CV risk and a baseline estimated glomerular filtration rate (eGFR) of at least 60 mL/min/1.73 m². Participants were randomly assigned to an intensive or standard systolic BP goal.

Results indicated that among the intensive and standard groups, the difference in adjusted mean eGFR was –3.32 mL/min/1.73 m² (95% CI, –3.90 to –2.74 mL/min/1.73 m²) at 6 months and –4.50 mL/min/1.73 m² (95% CI, –5.16 to –3.85 mL/min/1.73 m²) at 18 months. Afterwards, the difference remained generally constant.

In 3-year data, 3.7% of participants in the intensive group and 1% of participants in the standard group experienced an incident CKD event (HR = 3.54; 95% CI, 2.50-5.02). Conversely, the composite of death or CV event occurred in 4.9% of participants in the intensive group and 7.1% of those in the standard group (HR = 0.71; 95% CI, 0.59 to 0.86).

“Although an acute decrease in eGFR was observed in the intensive treatment group, the differences in mean eGFR remained relatively stable between groups,” Beddhu and colleagues concluded. “Intensive [systolic] BP lowering increased the risk for incident CKD events, but this was outweighed by the potential for cardiovascular and all-cause mortality benefits over the relatively short follow-up. None of the participants with incident CKD progressed to ESRD. The long-term consequences of incident CKD due to intensive [systolic] BP lowering need to be established.”

The researchers note that in some cases it may be more important to consider incident CKD than a CV event. – by Alaina Tedesco

Disclosures: Beddhu reports he receives grants from Bayer and AbbVie. Please see the study for all other researchers’ relevant financial disclosures.