TY - JOUR
T1 - Effect of Intensive Blood Pressure Control on Kidney Outcomes
T2 - Long-Term Electronic Health Record-Based Post-Trial Follow-Up of SPRINT
AU - Drawz, Paul E.
AU - Lenoir, Kristin M.
AU - Rai, Nayanjot Kaur
AU - Rastogi, Anjay
AU - Chu, Chi D.
AU - Rahbari-Oskoui, Frederic F.
AU - Whelton, Paul K.
AU - Thomas, George
AU - McWilliams, Andrew
AU - Agarwal, Anil K.
AU - Suarez, Maritza Marie
AU - Dobre, Mirela
AU - Powell, James
AU - Rocco, Michael V.
AU - Lash, James P.
AU - Oparil, Suzanne
AU - Raj, Dominic S.
AU - Dwyer, Jamie P.
AU - Rahman, Mahboob
AU - Soman, Sandeep
AU - Townsend, Raymond R.
AU - Pemu, Priscilla
AU - Horwitz, Edward
AU - Ix, Joachim H.
AU - Tuot, Delphine S.
AU - Ishani, Areef
AU - Pajewski, Nicholas M.
N1 - Publisher Copyright:
© 2024 Lippincott Williams and Wilkins. All rights reserved.
PY - 2024/2
Y1 - 2024/2
N2 - BackgroundIntensive BP lowering in the Systolic Blood Pressure Intervention Trial (SPRINT) produced acute decreases in kidney function and higher risk for AKI. We evaluated the effect of intensive BP lowering on long-term changes in kidney function using trial and outpatient electronic health record (EHR) creatinine values.MethodsSPRINT data were linked with EHR data from 49 (of 102) study sites. The primary outcome was the total slope of decline in eGFR for the intervention phase and the post-trial slope of decline during the observation phase using trial and outpatient EHR values. Secondary outcomes included a ≥30% decline in eGFR to <60 ml/min per 1.73 m2and a ≥50% decline in eGFR or kidney failure among participants with baseline eGFR ≥60 and <60 ml/min per 1.73 m2, respectively.ResultsEHR creatinine values were available for a median of 8.3 years for 3041 participants. The total slope of decline in eGFR during the intervention phase was -0.67 ml/min per 1.73 m2per year (95% confidence interval [CI], -0.79 to -0.56) in the standard treatment group and -0.96 ml/min per 1.73 m2per year (95% CI, -1.08 to -0.85) in the intensive treatment group (P < 0.001). The slopes were not significantly different during the observation phase: -1.02 ml/min per 1.73 m2per year (95% CI, -1.24 to -0.81) in the standard group and -0.85 ml/min per 1.73 m2per year (95% CI, -1.07 to -0.64) in the intensive group. Among participants without CKD at baseline, intensive treatment was associated with higher risk of a ≥30% decline in eGFR during the intervention (hazard ratio, 3.27; 95% CI, 2.43 to 4.40), but not during the postintervention observation phase. In those with CKD at baseline, intensive treatment was associated with a higher hazard of eGFR decline only during the intervention phase (hazard ratio, 1.95; 95% CI, 1.03 to 3.70).ConclusionsIntensive BP lowering was associated with a steeper total slope of decline in eGFR and higher risk for kidney events during the intervention phase of the trial, but not during the postintervention observation phase.
AB - BackgroundIntensive BP lowering in the Systolic Blood Pressure Intervention Trial (SPRINT) produced acute decreases in kidney function and higher risk for AKI. We evaluated the effect of intensive BP lowering on long-term changes in kidney function using trial and outpatient electronic health record (EHR) creatinine values.MethodsSPRINT data were linked with EHR data from 49 (of 102) study sites. The primary outcome was the total slope of decline in eGFR for the intervention phase and the post-trial slope of decline during the observation phase using trial and outpatient EHR values. Secondary outcomes included a ≥30% decline in eGFR to <60 ml/min per 1.73 m2and a ≥50% decline in eGFR or kidney failure among participants with baseline eGFR ≥60 and <60 ml/min per 1.73 m2, respectively.ResultsEHR creatinine values were available for a median of 8.3 years for 3041 participants. The total slope of decline in eGFR during the intervention phase was -0.67 ml/min per 1.73 m2per year (95% confidence interval [CI], -0.79 to -0.56) in the standard treatment group and -0.96 ml/min per 1.73 m2per year (95% CI, -1.08 to -0.85) in the intensive treatment group (P < 0.001). The slopes were not significantly different during the observation phase: -1.02 ml/min per 1.73 m2per year (95% CI, -1.24 to -0.81) in the standard group and -0.85 ml/min per 1.73 m2per year (95% CI, -1.07 to -0.64) in the intensive group. Among participants without CKD at baseline, intensive treatment was associated with higher risk of a ≥30% decline in eGFR during the intervention (hazard ratio, 3.27; 95% CI, 2.43 to 4.40), but not during the postintervention observation phase. In those with CKD at baseline, intensive treatment was associated with a higher hazard of eGFR decline only during the intervention phase (hazard ratio, 1.95; 95% CI, 1.03 to 3.70).ConclusionsIntensive BP lowering was associated with a steeper total slope of decline in eGFR and higher risk for kidney events during the intervention phase of the trial, but not during the postintervention observation phase.
KW - CKD
KW - hypertension
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U2 - 10.2215/CJN.0000000000000335
DO - 10.2215/CJN.0000000000000335
M3 - Article
C2 - 37883184
AN - SCOPUS:85182756191
SN - 1555-9041
VL - 19
SP - 213
EP - 223
JO - Clinical Journal of the American Society of Nephrology
JF - Clinical Journal of the American Society of Nephrology
IS - 2
ER -