CKD: intensive hypertension treatment tied to reduced ESRD risk

  • Ku E & al.
  • J Am Heart Assoc
  • 20 Aug 2019

  • International Clinical Digest
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Takeaway

  • 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.

Study design

  • 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.

Key results

  • 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

Limitations

  • May not extrapolate to diabetic CKD.
  • Cardiovascular events not captured.