Key result
Control to a lower mean arterial pressure goal (≤92 mmHg) significantly slowed the progression of pulse pressure compared to a usual goal (0.42 vs 1.08 mmHg/year, P=0.002).
Why the study?
Does a lower mean arterial pressure goal (≤92 mmHg) reduce the progression of pulse pressure in nondiabetic patients with nephrosclerosis?
RCT (n=1,094)
Randomly assigned
Does a lower mean arterial pressure goal (≤92 mmHg) reduce the progression of pulse pressure in nondiabetic patients with nephrosclerosis?
Absolute Event Rate: 0.42% vs 1.08%
p-value: p=0.002
Intensive blood pressure control to a lower MAP goal significantly slows the progression of pulse pressure, a marker of cardiovascular remodeling and risk, in patients with hypertensive nephrosclerosis.
Supports lower MAP targets in hypertensive nephrosclerosis for vascular protection; extends RCT evidence on intensive BP effects beyond renal outcomes.
Pulse pressure (PP), a marker of arterial system properties, has been linked to cardiovascular (CV) complications. We examined (a) association between unit changes of PP and (i) composite CV outcomes and (ii) development of left-ventricular hypertrophy (LVH) and (b) effect of mean arterial pressure (MAP) control on rate of change in PP. We studied 1094 nondiabetics with nephrosclerosis in the African American Study of Kidney Disease and Hypertension. Subjects were randomly assigned to usual MAP goal (102-107 mmHg) or a lower MAP goal (≤92 mmHg) and randomized to beta-blocker, angiotensin converting enzyme inhibitor, or calcium channel blocker. After covariate adjustment, a higher PP was associated with increased risk of CV outcome (RR = 1.28, CI = 1.11-1.47, P < 0.01) and new LVH (RR = 1.26, CI = 1.04-1.54, P = 0.02). PP increased at a greater rate in the usual than in lower MAP groups (slope ± SE: 1.08 ± 0.15 versus 0.42 ± 0.15 mmHg/year, P = 0.002), but not by the antihypertensive treatment assignment. Observations indicate that control to a lower MAP slows the progression of PP, a correlate of cardiovascular remodeling and complications, and may be beneficial to CV health.
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Randall et al. (2013) conducted an RCT in Hypertension with nephrosclerosis (n=1,094). Lower mean arterial pressure (MAP) goal vs. Usual MAP goal (102-107 mmHg) was evaluated on Rate of change in pulse pressure (PP) (p=0.002). Control to a lower mean arterial pressure goal (≤92 mmHg) significantly slowed the progression of pulse pressure compared to a usual goal (0.42 vs 1.08 mmHg/year, P=0.002).
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