Key result
Intensive BP lowering linked to steeper eGFR decline vs standard treatment during intervention but not after.
Why the study?
Intensive BP lowering in SPRINT caused acute decreases in kidney function and higher AKI risk, prompting evaluation of its effect on long-term kidney function changes using linked outpatient EHR data.
Does intensive blood pressure lowering affect long-term changes in kidney function in adults with hypertension and high cardiovascular risk?
Observational (n=3,041)
Randomized
Yes
Does intensive blood pressure lowering affect long-term changes in kidney function in adults with hypertension and high cardiovascular risk?
Intensive blood pressure lowering was associated with a steeper decline in eGFR during the active intervention phase, but this effect did not persist during long-term observational follow-up.
Answers are grounded in this paper and cite their sources.
May signal transient eGFR effects during intensive BP lowering; leaves open sustained kidney outcomes in high-risk hypertension.
BACKGROUND: Intensive BP lowering in the Systolic Blood Pressure Intervention Trial (SPRINT) produced acute decreases in kidney function and higher risk for AKI. We evaluated the effect of intensive BP lowering on long-term changes in kidney function using trial and outpatient electronic health record (EHR) creatinine values. METHODS: SPRINT data were linked with EHR data from 49 (of 102) study sites. The primary outcome was the total slope of decline in eGFR for the intervention phase and the post-trial slope of decline during the observation phase using trial and outpatient EHR values. Secondary outcomes included a ≥30% decline in eGFR to <60 ml/min per 1.73 m 2 and a ≥50% decline in eGFR or kidney failure among participants with baseline eGFR ≥60 and <60 ml/min per 1.73 m 2 , respectively. RESULTS: EHR creatinine values were available for a median of 8.3 years for 3041 participants. The total slope of decline in eGFR during the intervention phase was -0.67 ml/min per 1.73 m 2 per year (95% confidence interval [CI], -0.79 to -0.56) in the standard treatment group and -0.96 ml/min per 1.73 m 2 per year (95% CI, -1.08 to -0.85) in the intensive treatment group ( P < 0.001). The slopes were not significantly different during the observation phase: -1.02 ml/min per 1.73 m 2 per year (95% CI, -1.24 to -0.81) in the standard group and -0.85 ml/min per 1.73 m 2 per year (95% CI, -1.07 to -0.64) in the intensive group. Among participants without CKD at baseline, intensive treatment was associated with higher risk of a ≥30% decline in eGFR during the intervention (hazard ratio, 3.27; 95% CI, 2.43 to 4.40), but not during the postintervention observation phase. In those with CKD at baseline, intensive treatment was associated with a higher hazard of eGFR decline only during the intervention phase (hazard ratio, 1.95; 95% CI, 1.03 to 3.70). CONCLUSIONS: Intensive BP lowering was associated with a steeper total slope of decline in eGFR and higher risk for kidney events during the intervention phase of the trial, but not during the postintervention observation phase.
No takes yet. Share an insight, caveat, or question.
Drawz et al. (2023) conducted an observational in Hypertension (n=3,041). Intensive blood pressure lowering vs. Standard blood pressure control (target systolic BP <140 mm Hg) was evaluated on Total slope of decline in eGFR during the intervention phase (ml/min per 1.73 m2 per year) (p=<0.001). Intensive blood pressure lowering was associated with a steeper total slope of decline in eGFR during the intervention phase compared to standard treatment, but not during the postintervention observation phase.
Synapse has enriched 10 related papers. Consider them for comparative context: