Effects of intensive BP control in CKD

Alfred K. Cheung, Mahboob Rahman, David M. Reboussin, Timothy E. Craven, Tom Greene, Paul L. Kimmel, William Cushman, Amret T. Hawfield, Karen Johnson, Cora E. Lewis, Suzanne Oparil, Michael V. Rocco, Kaycee M. Sink, Paul K. Whelton, Jackson T. Wright, Jan Basile, Srinivasan Beddhu, Udayan Bhatt, Tara I. Chang, Glenn M. Chertow & 12 others Michel Chonchol, Barry I. Freedman, William Haley, Joachim H. Ix, Lois A. Katz, Anthony A. Killeen, Vasilios Papademetriou, Ana C. Ricardo, Karen Servilla, Barry Wall, Dawn Wolfgram, Jerry Yee

Research output: Contribution to journalArticle

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Abstract

The appropriate target for BP in patients with CKD and hypertension remains uncertain. We report prespecified subgroup analyses of outcomes in participants with baseline CKD in the Systolic Blood Pressure Intervention Trial. We randomly assigned participants to a systolic BP target of ,120 mm Hg (intensive group; n=1330) or ,140 mm Hg (standard group; n=1316). After a median follow-up of 3.3 years, the primary composite cardiovascular outcome occurred in 112 intensive group and 131 standard group CKD participants (hazard ratio [HR], 0.81; 95% confidence interval [95% CI], 0.63 to 1.05). The intensive group also had a lower rate of all-cause death (HR, 0.72; 95% CI, 0.53 to 0.99). Treatment effects did not differ between participantswith andwithoutCKD (P values for interactions$0.30). The prespecified main kidney outcome, defined as the composite of $50% decrease in eGFR from baseline or ESRD, occurred in 15 intensive group and 16 standard group participants (HR, 0.90; 95% CI, 0.44 to 1.83). After the initial 6 months, the intensive group had a slightly higher rate of change in eGFR (20.47 versus 20.32 ml/min per 1.73 m2 per year; P,0.03). The overall rate of serious adverse events did not differ between treatment groups, although some specific adverse events occurred more often in the intensive group. Thus, among patients with CKDand hypertensionwithout diabetes, targeting an SBP,120mmHg comparedwith,140 mm Hg reduced rates of major cardiovascular events and all-cause death without evidence of effect modifications by CKD or deleterious effect on the main kidney outcome.

Original languageEnglish (US)
Pages (from-to)2812-2823
Number of pages12
JournalJournal of the American Society of Nephrology
Volume28
Issue number9
DOIs
StatePublished - Sep 1 2017

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Confidence Intervals
Cause of Death
Blood Pressure
Kidney
Chronic Kidney Failure
Hypertension
Therapeutics

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

Cheung, A. K., Rahman, M., Reboussin, D. M., Craven, T. E., Greene, T., Kimmel, P. L., ... Yee, J. (2017). Effects of intensive BP control in CKD. Journal of the American Society of Nephrology, 28(9), 2812-2823. https://doi.org/10.1681/ASN.2017020148

Effects of intensive BP control in CKD. / Cheung, Alfred K.; Rahman, Mahboob; Reboussin, David M.; Craven, Timothy E.; Greene, Tom; Kimmel, Paul L.; Cushman, William; Hawfield, Amret T.; Johnson, Karen; Lewis, Cora E.; Oparil, Suzanne; Rocco, Michael V.; Sink, Kaycee M.; Whelton, Paul K.; Wright, Jackson T.; Basile, Jan; Beddhu, Srinivasan; Bhatt, Udayan; Chang, Tara I.; Chertow, Glenn M.; Chonchol, Michel; Freedman, Barry I.; Haley, William; Ix, Joachim H.; Katz, Lois A.; Killeen, Anthony A.; Papademetriou, Vasilios; Ricardo, Ana C.; Servilla, Karen; Wall, Barry; Wolfgram, Dawn; Yee, Jerry.

In: Journal of the American Society of Nephrology, Vol. 28, No. 9, 01.09.2017, p. 2812-2823.

Research output: Contribution to journalArticle

Cheung, AK, Rahman, M, Reboussin, DM, Craven, TE, Greene, T, Kimmel, PL, Cushman, W, Hawfield, AT, Johnson, K, Lewis, CE, Oparil, S, Rocco, MV, Sink, KM, Whelton, PK, Wright, JT, Basile, J, Beddhu, S, Bhatt, U, Chang, TI, Chertow, GM, Chonchol, M, Freedman, BI, Haley, W, Ix, JH, Katz, LA, Killeen, AA, Papademetriou, V, Ricardo, AC, Servilla, K, Wall, B, Wolfgram, D & Yee, J 2017, 'Effects of intensive BP control in CKD', Journal of the American Society of Nephrology, vol. 28, no. 9, pp. 2812-2823. https://doi.org/10.1681/ASN.2017020148
Cheung AK, Rahman M, Reboussin DM, Craven TE, Greene T, Kimmel PL et al. Effects of intensive BP control in CKD. Journal of the American Society of Nephrology. 2017 Sep 1;28(9):2812-2823. https://doi.org/10.1681/ASN.2017020148
Cheung, Alfred K. ; Rahman, Mahboob ; Reboussin, David M. ; Craven, Timothy E. ; Greene, Tom ; Kimmel, Paul L. ; Cushman, William ; Hawfield, Amret T. ; Johnson, Karen ; Lewis, Cora E. ; Oparil, Suzanne ; Rocco, Michael V. ; Sink, Kaycee M. ; Whelton, Paul K. ; Wright, Jackson T. ; Basile, Jan ; Beddhu, Srinivasan ; Bhatt, Udayan ; Chang, Tara I. ; Chertow, Glenn M. ; Chonchol, Michel ; Freedman, Barry I. ; Haley, William ; Ix, Joachim H. ; Katz, Lois A. ; Killeen, Anthony A. ; Papademetriou, Vasilios ; Ricardo, Ana C. ; Servilla, Karen ; Wall, Barry ; Wolfgram, Dawn ; Yee, Jerry. / Effects of intensive BP control in CKD. In: Journal of the American Society of Nephrology. 2017 ; Vol. 28, No. 9. pp. 2812-2823.
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