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September 18, 2020European Journal of Heart FailureOpen Access

Worsening renal function during intensive blood pressure control: another example of not prognostically relevant creatinine rise?

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Key result

The beneficial effect of intensive blood pressure control on heart failure events was not significantly modified by baseline renal function, despite an early decline in eGFR.

Why the study?

Does intensive blood pressure control reduce future heart failure events in non-diabetic patients with hypertension and high cardiovascular risk across the spectrum of baseline renal function?

Design

Editorial

Authors

MIMiyuki ItoYMYuya MatsueTMTohru Minamino

Discussion

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Member takes

Overview

Intensive BP lowering prevents HF events across kidney function and albuminuria; extends SPRINT benefits to CKD phenotypes.

Structured PICO

Does intensive blood pressure control reduce future heart failure events in non-diabetic patients with hypertension and high cardiovascular risk across the spectrum of baseline renal function?

P
Population
Over 9000 non-diabetic individuals over the age of 50 years with hypertension, high cardiovascular risk, and impaired renal function.
I
Intervention
Intensive blood pressure treatment (systolic blood pressure target <120 mmHg)
C
Comparator
Standard blood pressure treatment (systolic blood pressure target <140 mmHg)
O
Outcome
Composite of myocardial infarction, acute coronary syndrome, stroke, acute heart failure, or death from cardiovascular-related causes (SPRINT primary endpoint); future heart failure events (substudy focus)composite

Worsening renal function during intensive blood pressure control does not negate its benefits in preventing heart failure, suggesting antihypertensive therapy should not be discontinued solely due to an initial creatinine rise.

Limitations

  • Relatively short duration of follow-up in SPRINT
  • Very few end-stage kidney disease events during follow-up
  • BP lowering in each arm was not detailed
  • Unclear if any particular antihypertensive drug is strongly associated with lower heart failure events
  • Blood pressure lowering in each arm was not detailed
  • Unclear if there is any particular antihypertensive drug that is strongly associated with lower heart failure events

Cite This Study

Ito et al. (2020) conducted an editorial in Hypertension and high cardiovascular risk (n=9,000). Intensive blood pressure control vs. Standard treatment (SBP target <140 mmHg) was evaluated on Composite of myocardial infarction, acute coronary syndrome, stroke, acute heart failure, or death from cardiovascular-related causes. The beneficial effect of intensive blood pressure control on heart failure events was not significantly modified by baseline renal function, despite an early decline in eGFR.

synapsesocial.com/papers/6a5e476b52cbb8c07fe565d4https://doi.org/10.1002/ejhf.2000
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Implications of Early Decline in eGFR due to Intensive BP Control for Cardiovascular Outcomes in SPRINT2019 · 56 citations
  2. 2A Randomized Trial of Intensive versus Standard Blood-Pressure Control2015 · 6,372 citations
  3. 3Renal Effects and Associated Outcomes During Angiotensin-Neprilysin Inhibition in Heart Failure2018 · 457 citations
  4. 4Absolute Rates of Heart Failure, Coronary Heart Disease, and Stroke in Chronic Kidney Disease2016 · 165 citations
  5. 5Risk of Heart Failure in Type 2 Diabetes Complicated by Incident Ischaemic Heart Disease and End-Stage Renal Disease2020 · 7 citations