Results from a recent clinical trial indicate that intensive blood pressure lowering reduces chronic kidney disease (CKD) patients’ risks of dying prematurely or developing cardiovascular disease. The findings appear in an upcoming issue of the Journal of the American Society of Nephrology (JASN).
The appropriate target for blood pressure in patients with CKD and hypertension has been unclear. To examine the issue, researchers analyzed information from the Systolic Blood Pressure Intervention Trial (SPRINT), sponsored by the National Institutes of Health. SPRINT, which enrolled individuals aged greater than 50 years with systolic blood pressure of greater than 130 mmHg and at least one additional cardiovascular disease risk factor, compared targeting a systolic blood pressure to <120 mmHg vs. <140 mmHg for preventing cardiovascular complications and early death. The benefits of the lower target were apparent almost a year before the study was initially planned to end.
Alfred K. Cheung, MD (University of Utah) and company, found that individuals who had CKD at the start of the study experienced similar benefits as those without CKD. After a median follow-up of 3.3 years for 1330 CKD patients in the intensive group and 1316 in the standard group, the composite cardiovascular outcome (heart attack, acute coronary syndrome, acute decompensated heart failure, stroke, or heart-related death) occurred in 112 and 131 participants, respectively, translating to a 19% reduction in risk for intensive-group participants. Also, there were 70 deaths from any cause in the intensive group compared with 95 in the standard group, for a 28% reduction in risk.
Researchers found that older participants aged ?75 years benefited as much as those who were younger within this CKD subgroup. There was a slightly faster decline in kidney function in the intensive group, but no serious adverse events.
The author noted that, in people with CKD, lowering systolic blood pressure beyond the conventional goal reduced the risks of heart disease and death, but slightly hastened the decline in kidney function that often accompanies aging. These findings come from the largest randomized trial to date on the effects of blood pressure in patients with CKD.