Influence of Prediabetes on the Effects of Intensive Systolic Blood Pressure Control on Kidney Events.

Pubmed ID: 31257407

Pubmed Central ID: PMC6856623

Journal: American journal of hypertension

Publication Date: Nov. 15, 2019

Link: https://academic.oup.com/ajh/article/32/12/1170/5525427

MeSH Terms: Humans, Male, Female, Aged, Aged, 80 and over, Risk Factors, United States, Middle Aged, Prevalence, Hypertension, Randomized Controlled Trials as Topic, Risk Assessment, Treatment Outcome, Blood Pressure, Incidence, Puerto Rico, Time Factors, Glomerular Filtration Rate, Renal Insufficiency, Chronic, Databases, Factual, Kidney, Antihypertensive Agents, Acute Kidney Injury, Prediabetic State

Grants: HHSN268200900040C, HHSN268200900046C, HHSN268200900047C, HHSN268200900048C, HHSN268200900049C, UL1 RR025764, C06 RR011234, R01 DK091437, R21 DK106574, K24 DK085446, R21 HL145494, R01 DK118219, T35 DK103596

Authors: Beddhu S, Greene T, Cheung AK, Chertow GM, Whelton PK, Kimmel PL, Cushman WC, Wei G, Bress AP, Boucher R, Rathi N, Kramer HJ, Al-Marji C

Cite As: Rathi N, Whelton PK, Chertow GM, Cushman WC, Cheung AK, Wei G, Boucher R, Kimmel PL, Bress AP, Kramer HJ, Al-Marji C, Greene T, Beddhu S. Influence of Prediabetes on the Effects of Intensive Systolic Blood Pressure Control on Kidney Events. Am J Hypertens 2019 Nov 15;32(12):1170-1177.

Studies:

Abstract

BACKGROUND: More than one-third of US adults have prediabetes, which is typically accompanied by hypertension. METHODS: We examined whether prediabetes modified the effects of intensive systolic blood pressure (SBP) lowering on the incidence of chronic kidney disease (CKD) and acute kidney injury (AKI) events in a post-hoc analysis of the Systolic Blood Pressure Intervention Trial (SPRINT). Diabetes was a SPRINT exclusion criterion. We defined normoglycemia and prediabetes as fasting plasma glucose <100 mg/dl and ≥100 mg/dl, respectively. RESULTS: Of the 9,323 participants included in this analysis, 3,898 (41.8%) had prediabetes and the rest (5,425) had normoglycemia. In participants with baseline estimated glomerular filtration rate (eGFR) ≥60 ml/min/1.73 m2, incident CKD was defined as a ≥30% decline in eGFR to below 60 ml/min/1.73 m2 with repeat confirmation. AKI events were identified clinically. In the non-CKD participants (n = 6,678), there were 164 incident CKD events. The hazard ratios (HRs) for incident CKD for intensive SBP goal (<120 mm Hg) vs. standard SBP goal (<140 mm Hg) in the normoglycemia (HR: 3.25, 95% CI: 2.03, 5.19) and prediabetes (HR: 3.90, 95% CI: 2.17, 7.02) groups were similar (interaction P value 0.64). In the entire analytic cohort (N = 9,323), there were 310 AKI events. AKI HRs for intensive vs. standard SBP in the normoglycemia (HR: 1.59, 95% CI: 1.17, 2.15) and prediabetes (HR: 1.74, 95% CI: 1.22, 2.48) groups were also similar (interaction P value 0.71). CONCLUSIONS: Prediabetes was highly prevalent, but there was no evidence that prediabetes modified the effects of SPRINT intervention on kidney events.CLINICAL TRIALS REGISTRATIONNCT01206062.