- Intensive BP control is associated with reduced risk for progression to end-stage renal disease (ESRD) among patients with hypertension and chronic kidney disease (CKD).
Why this matters
- Benefit appears greatest with older age, obesity, or worse proteinuria.
- Recent meta-analysis supports reduced mortality risk in stage III-V CKD.
- Post hoc analysis, pooled data from MDRD (n=840) and AASK (n=1067).
- Mean age, 53 years; mean estimated glomerular filtration rate (eGFR, mL/minute/1.73 m2), 40; median proteinuria, 0.12 g/day.
- Strict BP control: target mean arterial pressure (MAP) ≤92 mmHg, age
- Usual control: target MAP ≤107 mmHg,
- Funding: NIH.
- During median 14.9 years:
- Strict control: 498 ESRD cases, 438 deaths.
- Usual control: 526 ESRD cases, 482 deaths.
- Strict vs usual control was tied to reduced risks (adjusted [a]HRs; 95% CIs) for:
- ESRD: 0.88 (0.78-0.99); and
- Death: 0.85 (0.75-0.97).
- Strict control was associated with reduced ESRD risk (aHRs, 95% CIs) in patients with:
- Proteinuria ≥0.44 g/day: 0.79 (0.65-0.96);
- Age ≥40 years: 0.85 (0.74-0.98); or
- BMI ≥30 kg/m2: 0.67 (0.54-0.82).
- Strict control was tied to reduced risk for death with eGFR
- May not extrapolate to diabetic CKD.
- Cardiovascular events not captured.