CV Benefits of Intensive SBP Reduction Outweigh Increased CKD Risk

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Researchers conducted a subgroup analysis of SPRINT to determine the effects of intensive BP lowering on CV and kidney outcomes.
Researchers conducted a subgroup analysis of SPRINT to determine the effects of intensive BP lowering on CV and kidney outcomes.

HealthDay News — Intensive systolic blood pressure (SBP) lowering is associated with an increased risk of chronic kidney disease (CKD) events but a reduced risk of cardiovascular events and mortality, according to a study published online in the Annals of Internal Medicine.

Srinivasan Beddhu, MD, from the University of Utah in Salt Lake City, and colleagues conducted subgroup analyses of the Systolic Blood Pressure Intervention Trial to determine the effects of intensive SBP lowering vs standard SBP lowering on kidney and cardiovascular outcomes in adults with high blood pressure and elevated cardiovascular risk. In the intervention, 6662 participants were randomly assigned to either the intensive (120 mm Hg) or standard (140 mm Hg) SBP goal.

The researchers found that the difference in adjusted mean estimated glomerular filtration rate was −3.32 mL/min/1.73 m2 between the intensive and standard groups at 6 months and −4.5 mL/min/1.73 m2 at 18 months. In the intensive group, an incident CKD event occurred in 3.7% of participants vs 1% in the standard group at 3-year follow-up (hazard ratio, 3.54). The composite of death or cardiovascular event occurred in 4.9% and 7.1% of participants in the intensive and standard groups, respectively, at 3-year follow-up (hazard ratio, 0.71).

"Intensive SBP lowering increased risk for incident CKD events, but this was outweighed by cardiovascular and all-cause mortality benefits," the authors concluded.

Disclosures: Several authors report financial ties to the pharmaceutical industry.

Reference

Beddhu S, Rocco MV, Toto R, et al; for the SPRING Research Group. Effects of intensive systolic blood pressure control on kidney and cardiovascular outcomes in persons without kidney disease: a secondary analysis of a randomized trial [published online September 5, 2017]. Ann Intern Med. doi:10.7326/M16-2966

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