Intensive Blood Pressure Control May Not Benefit CKD Patients

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Post hoc analysis of SPRINT finds no significant difference in the incidence of fatal and nonfatal cardiovascular events among patients with moderate-to-advanced chronic kidney disease.
Post hoc analysis of SPRINT finds no significant difference in the incidence of fatal and nonfatal cardiovascular events among patients with moderate-to-advanced chronic kidney disease.

Intensive blood pressure (BP) control in nondiabetic patients with moderate-to-advanced chronic kidney disease may not lower their cardiovascular risks and could increase their risk of acute kidney injury (AKI), according to a new study published online ahead of print in the Journal of Internal Medicine.

In a post hoc analysis of SPRINT (Systolic Blood Pressure Intervention Trial), Yoshitsugu Obi, MD, of the University of California Irvine, and colleagues found that intensive BP control did not reduce the risk of fatal and nonfatal cardiovascular events among 891 patients with an estimated glomerular filtration rate (eGFR) below 45 mL/min/1.73 m2. The group consisted of 445 patients who received standard BP control and 446 who received intensive BP control. Fatal and nonfatal cardiovascular events occurred in 54 patients in each group.

AKI developed in 62 patients (13.9%) in the intensive control arm compared with 38 (8.5%) in the standard control arm. Intensive BP control was associated with a significant 73% increased risk of AKI.

SPRINT enrolled 9361 nondiabetic hypertensive adults with an eGFR above 20 mL/min/1.73 m2 from 102 US facilities from November 2010 to March 2013. Patients were followed up until August 2015. The median follow-up was 3.26 years. Patients were randomly assigned to a systolic BP target of either less than 120 (intensive treatment) or less than 140 mm Hg (standard treatment). SPRINT originally reported that intensive BP control, while increasing the incidence of AKI, decreased the risk of cardiovascular events, a benefit not modified by the presence of CKD.

Based on the current findings, Dr Obi and colleagues concluded that eGFR significantly modifies the risk-benefit profile of intensive BP control, which may provide little or no benefit and may be harmful to patients with an eGFR below 45 mL/min/1.73 m2.

Reference

Obi Y, Kalantar-Zadeh K, Shintani, et al. Estimated glomerular filtration rate and the risk-benefit profile of intensive blood pressure control amongst nondiabetic patients: a post hoc analysis of a randomized clinical trial. J Intern Med. 2017; published online ahead of print. doi: 10.1111/joim.12701

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