June 30, 2016European Heart Journal - Quality of Care and Clinical Outcomes

Intensive systolic blood pressure reduction to ≤130 mmHg was associated with a slower decline in eGFR in an analysis of 8,778 patients, but conclusive evidence from dedicated randomized trials is lacking.

Q: What is the clinical evidence from this study?

Study design: Editorial. Population: Chronic Kidney Disease and Hypertension. Intervention: Intensive blood pressure reduction vs. Standard blood pressure targets. Primary outcome: CKD progression (decline in eGFR or progression to ESRD).

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Design

Editorial

Key result

Intensive systolic blood pressure reduction to ≤130 mmHg was associated with a slower decline in eGFR in an analysis of 8,778 patients, but conclusive evidence from dedicated randomized trials is lacking.

Authors

WMWilliam E. MoodyCardiac Imaging CFCharles J. FerroGeneral Cardiology JTJohn TownendInterventional Cardiology

Discussion

Member takes

Overview

Intensive BP targets should not yet change CKD practice; leaves open whether phenotype-stratified RCTs can resolve the RCT-observational gap.

PICO

Population

An editorial reviewing evidence from the LIFE, SPRINT, MDRD, and AASK trials on whether intensive blood pressure reduction slows the progression of chronic kidney disease.

Intervention / Comparator

Intensive blood pressure reduction vs Standard blood pressure targets

Primary Outcome

CKD progression (decline in eGFR or progression to ESRD)

This editorial emphasizes the discrepancy between observational data and randomized trials regarding intensive blood pressure control for CKD progression, calling for new, adequately powered trials stratified by patient phenotype.

Limitations

Observational studies may be confounded by baseline phenotype differences where lower blood pressure is associated with slowly progressing CKD for other reasons.
Previous randomized trials may have had insufficient blood pressure differences between groups and treatment durations that were too short.
There may be a plateau effect for kidney function below pressures of 140/90 mmHg.
Antihypertensive drugs used in trials may have exerted direct adverse effects on kidney function, outweighing potential benefits.

Cite This Study

Moody et al. (2016) conducted an editorial in Chronic Kidney Disease and Hypertension. Intensive blood pressure reduction vs. Standard blood pressure targets was evaluated on CKD progression (decline in eGFR or progression to ESRD). Intensive systolic blood pressure reduction to ≤130 mmHg was associated with a slower decline in eGFR in an analysis of 8,778 patients, but conclusive evidence from dedicated randomized trials is lacking.

synapsesocial.com/papers/6aaf712157c419f6dedcab72 https://doi.org/10.1093/ehjqcco/qcw035

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June 30, 2016European Heart Journal - Quality of Care and Clinical Outcomes

Intensive systolic blood pressure reduction to ≤130 mmHg was associated with a slower decline in eGFR in an analysis of 8,778 patients, but conclusive evidence from dedicated randomized trials is lacking.

View Full Paper

Ask AI

Bookmark

Design

Editorial

Key result

Authors

WMWilliam E. MoodyCardiac Imaging CFCharles J. FerroGeneral Cardiology JTJohn TownendInterventional Cardiology

Discussion

Member takes

Overview

Intensive BP targets should not yet change CKD practice; leaves open whether phenotype-stratified RCTs can resolve the RCT-observational gap.

PICO

Population

An editorial reviewing evidence from the LIFE, SPRINT, MDRD, and AASK trials on whether intensive blood pressure reduction slows the progression of chronic kidney disease.

Intervention / Comparator

Intensive blood pressure reduction vs Standard blood pressure targets

Primary Outcome

CKD progression (decline in eGFR or progression to ESRD)

Limitations

Observational studies may be confounded by baseline phenotype differences where lower blood pressure is associated with slowly progressing CKD for other reasons.
Previous randomized trials may have had insufficient blood pressure differences between groups and treatment durations that were too short.
There may be a plateau effect for kidney function below pressures of 140/90 mmHg.
Antihypertensive drugs used in trials may have exerted direct adverse effects on kidney function, outweighing potential benefits.

Cite This Study

synapsesocial.com/papers/6aaf712157c419f6dedcab72 https://doi.org/10.1093/ehjqcco/qcw035

Also Consider

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

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