Estimated glomerular filtration rate and the risk–benefit profile of intensive blood pressure control amongst nondiabetic patients: a post hoc analysis of a randomized clinical trial

Abstract Background The Systolic Blood Pressure Intervention Trial ( SPRINT ; ClinicalTrials.gov , NCT 01206062) reported reduced cardiovascular events by intensive blood pressure ( BP ) control amongst hypertensive patients without diabetes. However, the risk–benefit profile of intensive BP control may differ across estimated glomerular filtration rate ( eGFR ) levels. Methods This is a post hoc analysis of the SPRINT . Nondiabetic hypertensive adults ( n = 9361) with eGFR >20 mL per min per 1.73 m 2 were enrolled from 102 US facilities between November 2010 and March 2013 and were followed up until August 2015 (median follow‐up, 3.26 years). Patients were randomly assigned to either a systolic BP target of <120 or <140 mmHg (for intensive or standard treatment, respectively). The outcomes of interests were the development of (i) fatal and nonfatal major cardiovascular events and (ii) acute kidney injury ( AKI ). Results The cardiovascular benefit from intensive treatment was attenuated with lower eGFR ( P interaction = 0.019), whereas eGFR did not modify the adverse effect on AKI ( P interaction = 0.179). Amongst 891 participants with eGFR <45 mL per min per 1.73 m 2 , intensive treatment did not reduce the cardiovascular outcome (54/446 vs. 54/445 events in the standard group, respectively; hazard ratio HR , 0.92; 95% CI , 0.62–1.38) with an absolute rate difference ( ARD ) of −0.02 (95% CI , −0.07 to +0.03) per 100 patient‐years, whereas it increased AKI (62/446 vs. 38/445 events in the standard group; HR , 1.73; 95% CI , 1.12–2.66) with an ARD of +1.93 (95% CI , +1.88 to +1.97) per 100 patient‐years. Conclusions Intensive BP control may provide little or no benefit and even be harmful for patients with moderate‐to‐advanced chronic kidney disease.