CKD: statins + intensive BP control extend survival

  • Rivera M & al.
  • Am J Nephrol
  • 27 Mar 2019

  • International Clinical Digest
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Takeaway

  • Antihypertensive therapy and statins appear to have a synergistic effect in lowering mortality risk that transcends cholesterol reduction among patients with nondiabetic chronic kidney disease (CKD).

Why this matters

  • The survival benefit was greater than that observed in the original SPRINT CKD study, which found a 28% reduced risk for all-cause mortality.
  • Other studies have pointed to statin benefits beyond cholesterol lowering.

Study design

  • Post hoc analysis of the SPRINT trial, focusing on 2646 patients with CKD (stage IIIa, 66%; IIIb, 28%; IV, 6%) randomly assigned to an intensive (
  • 51.2% were receiving a statin, 48.1% were not, and status was unknown for the remainder (n=19).
  • Median follow-up, 3.26 years.
  • Funding: None disclosed.

Key results

  • Statins + intensive systolic blood pressure (SBP) targeting yielded a 56% reduced risk for all-cause mortality (1.16 vs 2.5 per 100 patient-years [PY]: aHR=0.44; P=.009).
  • Statins + intensive SBP targeting yielded a 71% lower risk for cardiovascular mortality (0.28 vs 0.92 per 100 PY: aHR=0.29; P=.021).
  • Without statins, there was no difference between intensive and standard SBP targeting on all-cause (2.01 vs 1.94 per 100 PY) or cardiovascular mortality (0.52 vs 0.41 per 100 PY).

Limitations

  • Nonrandomized statin use, captured only at baseline.
  • Diabetic patients excluded.

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