For nondiabetic chronic kidney disease (CKD) patients with hypertension, combining statin therapy with intensive management of systolic blood pressure (SBP) may improve survival. Gabriel Contreras, MD, MPH, of the University of Miami in Florida and collaborators discussed the new study findings in a recent issue of the American Journal of Nephrology.
In a post hoc analysis of SPRINT (Systolic Blood Pressure Intervention Trial) focusing on the 2646 patients with CKD (estimated glomerular filtration rate less than 60 mL/min/1.73 m2), 1354 patients were taking a statin and 1273 were not. In the statin group, targeting an intensive SBP goal of less than 120 mm Hg compared with a standard SBP goal (less than 140 mm Hg) significantly reduced the risks for all-cause mortality by 56% and cardiovascular mortality by 71% over 3.3 years. The no-statin group, however, experienced no significant differences in all-cause or cardiovascular mortality by SBP regimen.
The potential survival advantage with statins was greater than in the original SPRINT CKD study, which found 28% lower risks of dying from any cause with intensive SBP control. Several other recent studies have suggested that statins benefit patients beyond lowering cholesterol.
“This synergistic effect stemming from the combination of antihypertensive therapy and statins appears to transcend cholesterol reduction uniquely and suggests a more intricate form of statin-mediated vascular pleiotropic effect,” Dr Contreras and colleagues stated.
With respect to serious adverse events, CKD patients on statin therapy assigned to the intensive SBP arm had a 52% higher risk for acute kidney injury (AKI). They were also at risk for hypokalemia.
“It is thus recommended that renal function tests be closely monitored in CKD patients when intensifying BP control,” Dr Contretras and his team cautioned. “Characteristics such older age, nonwhite race, lower baseline eGFR, and history of CVD warrant particular attention as these have been found to confer a higher risk for AKI.”
A recent study published BMC Nephrology also found modestly increased risks for AKI hospitalization among older adults taking higher doses of statins.
Rivera M, Tamariz L, Suarez M, and Contreras G. Modifying effect of statins on fatal outcomes in chronic kidney disease patients in the Systolic Blood Pressure Intervention Trial: A post hoc analysis. Am J Nephrol 2019;49:297–306. DOI: 10.1159/000499188
Tonelli M, Lloyd AM, Bello AK. Statin use and the risk of acute kidney injury in older adults. BMC Nephrol 201920:103. DOI:10.1186/s12882-019-1280-7