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

Y. Obi, K. Kalantar-Zadeh, A. Shintani, Csaba Kovesdy, T. Hamano

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: The Systolic Blood Pressure Intervention Trial (SPRINT; ClinicalTrials.gov, NCT01206062) 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 m2 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 (Pinteraction = 0.019), whereas eGFR did not modify the adverse effect on AKI (Pinteraction = 0.179). Amongst 891 participants with eGFR <45 mL per min per 1.73 m2, 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.

Original languageEnglish (US)
Pages (from-to)314-327
Number of pages14
JournalJournal of Internal Medicine
Volume283
Issue number3
DOIs
StatePublished - Mar 1 2018

Fingerprint

Glomerular Filtration Rate
Randomized Controlled Trials
Blood Pressure
Acute Kidney Injury
Chronic Renal Insufficiency
Therapeutics

All Science Journal Classification (ASJC) codes

  • Internal Medicine

Cite this

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. / Obi, Y.; Kalantar-Zadeh, K.; Shintani, A.; Kovesdy, Csaba; Hamano, T.

In: Journal of Internal Medicine, Vol. 283, No. 3, 01.03.2018, p. 314-327.

Research output: Contribution to journalArticle

@article{b14c942ffb6d4279926462efd2ee0d64,
title = "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, NCT01206062) 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 m2 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 (Pinteraction = 0.019), whereas eGFR did not modify the adverse effect on AKI (Pinteraction = 0.179). Amongst 891 participants with eGFR <45 mL per min per 1.73 m2, 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.",
author = "Y. Obi and K. Kalantar-Zadeh and A. Shintani and Csaba Kovesdy and T. Hamano",
year = "2018",
month = "3",
day = "1",
doi = "10.1111/joim.12701",
language = "English (US)",
volume = "283",
pages = "314--327",
journal = "Journal of Internal Medicine",
issn = "0954-6820",
publisher = "Wiley-Blackwell",
number = "3",

}

TY - JOUR

T1 - Estimated glomerular filtration rate and the risk–benefit profile of intensive blood pressure control amongst nondiabetic patients

T2 - a post hoc analysis of a randomized clinical trial

AU - Obi, Y.

AU - Kalantar-Zadeh, K.

AU - Shintani, A.

AU - Kovesdy, Csaba

AU - Hamano, T.

PY - 2018/3/1

Y1 - 2018/3/1

N2 - Background: The Systolic Blood Pressure Intervention Trial (SPRINT; ClinicalTrials.gov, NCT01206062) 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 m2 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 (Pinteraction = 0.019), whereas eGFR did not modify the adverse effect on AKI (Pinteraction = 0.179). Amongst 891 participants with eGFR <45 mL per min per 1.73 m2, 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.

AB - Background: The Systolic Blood Pressure Intervention Trial (SPRINT; ClinicalTrials.gov, NCT01206062) 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 m2 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 (Pinteraction = 0.019), whereas eGFR did not modify the adverse effect on AKI (Pinteraction = 0.179). Amongst 891 participants with eGFR <45 mL per min per 1.73 m2, 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.

UR - http://www.scopus.com/inward/record.url?scp=85034274098&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85034274098&partnerID=8YFLogxK

U2 - 10.1111/joim.12701

DO - 10.1111/joim.12701

M3 - Article

VL - 283

SP - 314

EP - 327

JO - Journal of Internal Medicine

JF - Journal of Internal Medicine

SN - 0954-6820

IS - 3

ER -