What does this research mean for the field?

Intensive blood pressure control combined with an ACE inhibitor produces an additive reduction in proteinuria, resulting in a 35% greater reduction over 6 months compared to usual blood pressure control with an ACE inhibitor in CKD patients. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

March 25, 2023Journal of Human HypertensionOpen Access

Additive effects of intensive BP control and ACE inhibition on suppression of proteinuria in patients with CKD

Q: What is the clinical evidence from this study?

Study design: Letter. Population: Chronic Kidney Disease with proteinuria (n=240). Intervention: Intensive blood pressure control + ACE inhibitor vs. Usual blood pressure control + ACE inhibitor. Primary outcome: Ratio of proportional change in protein/creatinine ratio (PCR) between baseline and month 6 (Ratio 0.65, 95% CI 0.42-0.99, p=0.045).

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Key result

Intensive BP control with an ACEi achieves ~35% greater proteinuria reduction versus usual BP control.

Ratio 0.65
95% CI 0.42-0.99
P=0.045
n=240

Why the study?

The synergistic effects of RAAS inhibition and intensive blood pressure lowering in reducing proteinuria have not been well studied.

Does intensive blood pressure control combined with ACE inhibition reduce proteinuria in patients with CKD?

Population

Patients from the AASK Trial

Comparison

RAAS inhibition combined with intensive blood pressure lowering

Authors

RLRafael LopezInstituto de Investigación Sanitaria de Santiago TCTimothy P. CopelandUniversity of California, San Francisco CMCharles E. McCullochSemmelweis University

Discussion

Member takes

Implication

Should not yet change RAAS or BP targets in CKD; hypothesis-generating from AASK data and requires prospective RCTs for validation.

Structured PICO

Does intensive blood pressure control combined with ACE inhibition reduce proteinuria in patients with CKD?

Population

240 Black patients with chronic kidney disease and baseline proteinuria (PCR > 0.22 g/g), mean age 51 years, followed for 6 months.

Intervention

Intensive blood pressure control combined with ACE inhibition (RAAS inhibition)

Outcome

Reduction of proteinuriasurrogate

Main Result

Relative Risk: 0.65 (95% CI 0.42–0.99)

p-value: p=0.045

Intensive blood pressure control combined with ACE inhibition provides an additive and synergistic reduction of proteinuria in patients with CKD.

Limitations

Findings may not apply to patients in the general population who may differ from trial participants.
The AASK Trial only recruited Black participants, and findings may not apply to those of other racial or ethnic groups.
Lack of data on whether the participants had hyperaldosteronism and its role on treatment effects or suppression of proteinuria.
Only a subset of patients enrolled in the AASK Trial had substantial proteinuria.

Cite This Study

Lopez et al. (2023) conducted a letter in Chronic Kidney Disease with proteinuria (n=240). Intensive blood pressure control + ACE inhibitor vs. Usual blood pressure control + ACE inhibitor was evaluated on Ratio of proportional change in protein/creatinine ratio (PCR) between baseline and month 6 (Ratio 0.65, 95% CI 0.42-0.99, p=0.045). Intensive blood pressure control combined with an ACE inhibitor resulted in a 35% greater reduction in proteinuria over 6 months compared to usual blood pressure control with an ACE inhibitor (ratio 0.65).

synapsesocial.com/papers/6aa533e73f91f0dc5278e514 https://doi.org/10.1038/s41371-023-00823-z

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Additive effects of intensive BP control and ACE inhibition on suppression of proteinuria in patients with CKD

Discussion

Member takes

Implication

Structured PICO

Main Result

Limitations

Cite This Study

Additive effects of intensive BP control and ACE inhibition on suppression of proteinuria in patients with CKD

Discussion

Member takes

Implication

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Also Consider