Effects of Intensive Blood Pressure Control in Patients with and without Albuminuria: <i>Post Hoc</i> Analyses from SPRINT.

Pubmed ID: 32669306

Pubmed Central ID: PMC7409741

Journal: Clinical journal of the American Society of Nephrology : CJASN

Publication Date: Aug. 7, 2020

Affiliation: Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah.

MeSH Terms: Humans, Male, Female, Aged, United States, Middle Aged, Hypertension, Treatment Outcome, Blood Pressure, Incidence, Kidney Diseases, Time Factors, Glomerular Filtration Rate, Kidney, Antihypertensive Agents, Albuminuria

Grants: HHSN268200900049C, P30 GM103337, UL1 TR000433, C06 RR011234, R01 DK091437, R21 DK106574, K23 DK106515, R21 HL145494, UL1 TR002548, UL1 TR002538, UL1 TR003142

Authors: Weiner DE, Beddhu S, Drawz P, Rocco MV, Wall B, Berlowitz D, Hawfield A, Bhatt U, Horwitz E, Kramer H, Papademetriou V, Haley W, Wei G, Punzi H, Zias A, Grams ME, Chang AR, Freedman BI, Boucher R, Cohen DL, McLouth C, Morisky D

Cite As: Chang AR, Kramer H, Wei G, Boucher R, Grams ME, Berlowitz D, Bhatt U, Cohen DL, Drawz P, Punzi H, Freedman BI, Haley W, Hawfield A, Horwitz E, McLouth C, Morisky D, Papademetriou V, Rocco MV, Wall B, Weiner DE, Zias A, Beddhu S, for the SPRINT Research Group. Effects of Intensive Blood Pressure Control in Patients with and without Albuminuria: Post Hoc Analyses from SPRINT. Clin J Am Soc Nephrol 2020 Aug 7;15(8):1121-1128. Epub 2020 Jul 15.

Studies:

Abstract

BACKGROUND AND OBJECTIVES: It is unclear whether the presence of albuminuria modifies the effects of intensive systolic BP control on risk of eGFR decline, cardiovascular events, or mortality. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The Systolic Blood Pressure Intervention Trial randomized nondiabetic adults ≥50 years of age at high cardiovascular risk to a systolic BP target of &lt;120 or &lt;140 mm Hg, measured by automated office BP. We compared the absolute risk differences and hazard ratios of ≥40% eGFR decline, the Systolic Blood Pressure Intervention Trial primary cardiovascular composite outcome, and all-cause death in those with or without baseline albuminuria (urine albumin-creatinine ratio ≥30 mg/g). RESULTS: Over a median follow-up of 3.1 years, 69 of 1723 (4%) participants with baseline albuminuria developed ≥40% eGFR decline compared with 61 of 7162 (1%) participants without albuminuria. Incidence rates of ≥40% eGFR decline were higher in participants with albuminuria (intensive, 1.74 per 100 person-years; standard, 1.17 per 100 person-years) than in participants without albuminuria (intensive, 0.48 per 100 person-years; standard, 0.11 per 100 person-years). Although effects of intensive BP lowering on ≥40% eGFR decline varied by albuminuria on the relative scale (hazard ratio, 1.48; 95% confidence interval, 0.91 to 2.39 for albumin-creatinine ratio ≥30 mg/g; hazard ratio, 4.55; 95% confidence interval, 2.37 to 8.75 for albumin-creatinine ratio &lt;30 mg/g; <i>P</i> value for interaction &lt;0.001), the absolute increase in ≥40% eGFR decline did not differ by baseline albuminuria (incidence difference, 0.38 events per 100 person-years for albumin-creatinine ratio ≥30 mg/g; incidence difference, 0.58 events per 100 person-years for albumin-creatinine ratio &lt;30 mg/g; <i>P</i> value for interaction =0.60). Albuminuria did not significantly modify the beneficial effects of intensive systolic BP lowering on cardiovascular events or mortality evaluated on relative or absolute scales. CONCLUSIONS: Albuminuria did not modify the absolute benefits and risks of intensive systolic BP lowering.