Tight BP control cuts mortality in CKD

  • Aggarwal R & al.
  • Hypertension
  • 1 Jun 2019

  • International Clinical Digest
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Takeaway

  • 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

Study design

  • 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.

Key results

  • 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).

Limitations

  • Secondary, nonspecified analysis.

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