A low mean arterial pressure goal (≤92 mm Hg) slowed GFR decline over 3 years by a mean of 11.8 mL/min in blacks (P=0.11) and 0.3 mL/min in whites (P=0.81) compared to a usual goal (≤107 mm Hg).
RCT (n=548)
randomly assigned
Does a low mean arterial pressure goal reduce GFR decline in black and white patients with progressive renal disease?
A lower blood pressure goal (MAP <= 92 mm Hg) may be particularly important in slowing the progression of renal disease in black patients and those with proteinuria.
Effect estimate: 11.8 +/- 7.3 mL/min slower (blacks); 0.3 +/- 1.3 mL/min slower (whites)
p-value: p=0.11 (blacks), 0.81 (whites)
African Americans (blacks) have a disproportionately high incidence of end-stage renal disease due to hypertension. The Modification of Diet in Renal Disease (MDRD) Study found that strict blood pressure control slowed the decline in glomerular filtration rate (GFR) only in the subgroup of patients with proteinuria. The present report compares the effects of blood pressure control in black and white MDRD Study participants. Fifty-three black and 495 white participants with baseline GFRs of 25 to 55 mL/min/1.73 m2 were randomly assigned to a usual or low mean arterial pressure (MAP) goal of 1 g/d). In addition, a lower level of blood pressure control may be even more important in blacks than in whites in slowing the progression of renal disease.
Hebert et al. (Mon,) conducted a rct in Progressive Renal Disease (n=548). Low mean arterial pressure (MAP) goal vs. Usual MAP goal of <= 107 mm Hg was evaluated on GFR decline over 3 years (11.8 +/- 7.3 mL/min slower (blacks); 0.3 +/- 1.3 mL/min slower (whites), p=0.11 (blacks), 0.81 (whites)). A low mean arterial pressure goal (≤92 mm Hg) slowed GFR decline over 3 years by a mean of 11.8 mL/min in blacks (P=0.11) and 0.3 mL/min in whites (P=0.81) compared to a usual goal (≤107 mm Hg).