Intensive Systolic BP Control May Improve Cardiovascular Outcomes in High-Risk Patients Without CKD

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Study pooled data of all patients without chronic kidney disease from the ACCORD and SPRINT trials.
Study pooled data of all patients without chronic kidney disease from the ACCORD and SPRINT trials.

The following article is part of conference coverage from the 2018 AHA Scientific Sessions in Chicago, Illinois.The Cardiology Advisor's staff will be reporting breaking news associated with research conducted by leading experts in cardiology. Check back for the latest news from AHA 2018.

CHICAGO — For patients at high risk for cardiovascular events without baseline chronic kidney disease (CKD), a systolic blood pressure target of 120mmHg reduced negative cardiovascular outcomes but likely influenced the incidence of CKD. Results were presented at the Scientific Sessions of the American Heart Association, November 10-12, 2018. 

Researchers pooled data from the SPRINT (Systolic Blood Pressure Intervention Trial; ClinicalTrials.gov identifier: NCT01206062) and ACCORD (Action to Control Cardiovascular Risk in Diabetes; ClinicalTrials.gov identifier: NCT00000620) randomized controlled trials to evaluate the effect a systolic blood pressure target has on developing chronic kidney disease.

Patients with high cardiovascular risk but without chronic kidney disease were assigned to either an intensive systolic blood pressure target arm (120mmHg; n=5479), or to a standard systolic blood pressure target arm (140mmHg; n=5505). Incident CKD outcome was defined as an estimated glomerular filtration rate of ≥30% to a level <60mL/min/1.73m2.

In patients without CKD, the incident CKD event rate was not found to be independent of treatment group stratification (13.9% and 7.0% in the intensive systolic blood pressure target arm and standard blood pressure target arm, respectively; chi-square, 137.42, P <.001).

However, the rates of stroke (hazard ratio [HR], 0.69; 95% CI, 0.51-0.95; =.02), heart failure (HR, 0.76; 95% CI, 0.57-0.99; P =.04), and SPRINT Primary Outcome (HR, 0.82; 95% CI, 0.72-0.93; P =.002) were significantly reduced in the intensive systolic blood pressure target arm.

The researchers concluded that while systolic blood pressure target of 120 mmHg reduced rates of stroke, heart failure, and all-cause mortality, it also influenced the likelihood of CKD.

They note that “clinicians should consider [cardiovascular] benefits of intensive targets along with potential renal effects in clinical decision making.”

For more coverage of AHA 2018, click here.

Reference

Chiu N, Steinkamp J, Mirzan H, Aggarwal R. Systolic blood pressure control improves cardiovascular outcomes and influences risk for renal events in patients without kidney disease. Presented at: 2018 AHA 2018; November 10-12, 2018; Chicago, Illinois. Abstract Sa4039/4039.

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