- Intensively targeting systolic BP (SBP) to
Why this matters
- Guidelines for SBP targets in CKD have been inconsistent due to lack of adequately powered randomized controlled trials.
- Findings support SBP targets
- Pooled individual patient data from 4983 participants (mean age, 64.0 years; 41.4% female) with CKD and hypertension from 4 multicenter, randomized controlled trials: AASK, ACCORD, MDRD, and SPRINT.
- Intervention: intensive (
- Funding: None.
- Average SBP attained at 1 year: 125.0 mmHg with intensive target vs 136.9 mmHg with standard target.
- Deaths over median 3.5-year follow-up:
- 153 (1.71%/year) with intensive target.
- 173 (1.95%/year) with standard target.
- In primary analysis, the effect of intensive BP lowering on all-cause mortality failed to achieve statistical significance (HR=0.87; 95% CI, 0.69-1.08; P=.21).
- After excluding patients with glomerular filtration rate ≥60 mL/minute/1.73 m2 and those undergoing intensive glycemic control in ACCORD, intensive BP lowering was associated with reduced all-cause mortality (HR=0.79; P=.048).
- Secondary, nonspecified analysis.