scholarly journals Cognitive Function and Kidney Disease: Baseline Data From the Systolic Blood Pressure Intervention Trial (SPRINT)

2017 ◽  
Vol 70 (3) ◽  
pp. 357-367 ◽  
Author(s):  
Daniel E. Weiner ◽  
Sarah A. Gaussoin ◽  
John Nord ◽  
Alexander P. Auchus ◽  
Gordon J. Chelune ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cognitive Function ◽  
Kidney Disease ◽  
Systolic Blood Pressure ◽  
Baseline Data ◽  
Intervention Trial

scholarly journals The Association between the Montreal Cognitive Assessment and Functional Activity Questionnaire in the Systolic Blood Pressure Intervention Trial (SPRINT)

2018 ◽  
Vol 34 (6) ◽  
pp. 814-824
Author(s):  
Carolyn H Still ◽  
Nicholas M Pajewski ◽  
Gordon J Chelune ◽  
Stephen R Rapp ◽  
Kaycee M Sink ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cognitive Function ◽  
Systolic Blood Pressure ◽  
Functional Activity ◽  
Cognitive Assessment ◽  
Intervention Trial ◽  
Functional Difficulties ◽  
Global Cognitive Function ◽  
Functional Activity Questionnaire ◽  
Activity Questionnaire

Abstract Objective To examine the association of global cognitive function assessed via the Montreal Cognitive Assessment (MoCA) and deficiencies in instrumental activities of daily living (IADL) on the Functional Activity Questionnaire (FAQ) in hypertensive older adults in the Systolic Blood Pressure Intervention Trial (SPRINT). Methods In cross-sectional analysis, 9,296 SPRINT participants completed the MoCA at baseline. The FAQ was obtained from 2,705 informants for SPRINT participants scoring <21 or <22 on the MoCA, depending on education. FAQ severity ranged from no dysfunction (Score = 0) to moderate/severe dysfunction (Score = 5+). Results Participants who triggered FAQ administration were older, less educated, and more likely to be Black or Hispanic (p < 0.001). Sixty-one percent (n = 1,661) of participants’ informants reported no functional difficulties in IADLs. An informant report, however, of any difficulty on the FAQ was associated with lower MoCA scores after controlling for age, sex, race/ethnicity, and education (p < 0.05). Partial proportional odds regression indicates that participants scoring lower on the MoCA (in the 10th to <25th, fifth to <10th, and <fifth percentiles) had higher adjusted odds of their informant indicating dysfunction on the FAQ, relative to participants scoring at or above the 25th percentile on the MoCA (p < 0.001). Conclusions While lower global cognitive function was strongly associated with IADL deficits on FAQ, informants indicated no functional difficulties for the majority of SPRINT participants, despite low MoCA scores. These findings can help with designing future studies which aim to detect mild cognitive impairment and/or dementia in large, community-dwelling populations.

scholarly journals Arterial stiffness and kidney disease progression in the systolic blood pressure intervention trial

2020 ◽  
Vol 94 (1) ◽  
pp. 26-35
Author(s):  
Kristen L. Nowak ◽  
Michel Chonchol ◽  
Anna Jovanovich ◽  
Zhiying You ◽  
Walter T. Ambrosius ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Kidney Disease ◽  
Arterial Stiffness ◽  
Systolic Blood Pressure ◽  
Disease Progression ◽  
Intervention Trial ◽  
Kidney Disease Progression

scholarly journals Urinary Biomarkers of Tubular Damage Are Associated with Mortality but Not Cardiovascular Risk among Systolic Blood Pressure Intervention Trial Participants with Chronic Kidney Disease

2019 ◽  
Vol 49 (5) ◽  
pp. 346-355 ◽  
Author(s):  
Vasantha K. Jotwani ◽  
Alexandra K. Lee ◽  
Michelle M. Estrella ◽  
Ronit Katz ◽  
Pranav S. Garimella ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Systolic Blood Pressure ◽  
Strong Predictor ◽  
Urinary Biomarkers ◽  
Tubular Damage ◽  
Intervention Trial ◽  
Cvd Risk ◽  
Trial Participants

Background: Kidney tubulointerstitial fibrosis on biopsy is a strong predictor of chronic kidney disease (CKD) progression, and CKD is associated with elevated risk of cardiovascular disease (CVD). Tubular health is poorly quantified by traditional kidney function measures, including estimated glomerular filtration rate (eGFR) and albuminuria. We hypothesized that urinary biomarkers of tubular injury, inflammation, and repair would be associated with higher risk of CVD and mortality in persons with CKD. Methods: We measured urinary concentrations of interleukin-18 (IL-18), kidney injury molecule-1, neutrophil gelatinase-associated lipocalin, monocyte chemoattractant protein-1, and chitinase-3-like protein-1 (YKL-40) at baseline among 2,377 participants of the Systolic Blood Pressure Intervention Trial who had an eGFR < 60 mL/min/1.73 m2. We used Cox proportional hazards models to evaluate biomarker associations with CVD events and all-cause mortality. Results: At baseline, the mean age of participants was 72 ± 9 years, and eGFR was 48 ± 11 mL/min/1.73 m2. Over a median follow-up of 3.8 years, 305 CVD events (3.6% per year) and 233 all-cause deaths (2.6% per year) occurred. After multivariable adjustment including eGFR, albuminuria, and urinary creatinine, none of the biomarkers showed statistically significant associations with CVD risk. Urinary IL-18 (hazard ratio [HR] per 2-fold higher value, 1.14; 95% CI 1.01–1.29) and YKL-40 (HR per 2-fold higher value, 1.08; 95% CI 1.02–1.14) concentrations were each incrementally associated with higher mortality risk. Associations were similar when stratified by randomized blood pressure arm. Conclusions: Among hypertensive trial participants with CKD, higher urinary IL-18 and YKL-40 were associated with higher risk of mortality, but not CVD.

scholarly journals Association of Acute Kidney Injury with Cardiovascular Events and Death in Systolic Blood Pressure Intervention Trial

2019 ◽  
Vol 49 (5) ◽  
pp. 359-367
Author(s):  
Brad P. Dieter ◽  
Kenn B. Daratha ◽  
Sterling M. McPherson ◽  
Robert Short ◽  
Radica Z. Alicic ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Systolic Blood Pressure ◽  
Cardiovascular Events ◽  
Kidney Injury ◽  
Secondary Outcome ◽  
Intervention Trial ◽  
Major Cardiovascular Events

Rationale and Objective: In the Systolic Blood Pressure Intervention Trial, the possible relationships between acute kidney injury (AKI) and risk of major cardiovascular events and death are not known. Study Design: Post hoc analysis of a multicenter, randomized, controlled, open-label clinical trial. Setting and Participants: Hypertensive adults without diabetes who were ≥50 years of age with prior cardiovascular disease, chronic kidney disease (CKD), 10-year Framingham risk score > 15%, or age > 75 years were assigned to a systolic blood pressure target of < 120 mm Hg (intensive) or < 140 mm Hg (standard). Predictor: AKI episodes. Outcomes: The primary outcome was a composite of myocardial infarction, acute coronary syndrome, stroke, decompensated heart failure, or cardiovascular death. The secondary outcome was death from any cause. Analytical Approach: AKI was defined using the Kidney Disease: Improving Global Outcomes modified criteria based solely upon serum creatinine. AKI episodes were identified by serious adverse events or emergency room visits. Cox proportional hazards models assessed the risk for the primary and secondary outcomes by AKI status. Results: Participants were 68 ± 9 years of age, 36% women (3,332/9,361), and 30% Black race (2,802/9,361), and 17% (1,562/9,361) with cardiovascular disease. Systolic blood pressure was 140 ± 16 mm Hg at study entry. AKI occurred in 4.4% (204/4,678) and 2.6% (120/4,683) in the intensive and standard treatment groups respectively (p < 0.001). Those who experienced AKI had higher risk of cardiovascular events (hazard ratio [HR] 1.52, 95% CI 1.05–2.20, p = 0.026) and death from any cause (HR 2.33, 95% CI 1.56–3.48, p < 0.001) controlling for age, sex, race, baseline systolic blood pressure, body mass index, number of antihypertensive medications, cardiovascular disease and CKD status, hypotensive episodes, and treatment assignment. Limitations: The study was not prospectively designed to determine relationships between AKI, cardiovascular events, and death. Conclusions: Among older adults with hypertension at high cardiovascular risk, intensive treatment of blood pressure independently increased risk of AKI, which substantially raised risks of major cardiovascular events and death.

scholarly journals Hypertension Treatment and Concern About Falling: Baseline Data from the Systolic Blood Pressure Intervention Trial

2016 ◽  
Vol 64 (11) ◽  
pp. 2302-2306 ◽  
Author(s):  
Dan R. Berlowitz ◽  
Tonya Breaux-Shropshire ◽  
Capri G. Foy ◽  
Lisa H. Gren ◽  
Lewis Kazis ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Baseline Data ◽  
Hypertension Treatment ◽  
Intervention Trial

scholarly journals Blood pressure targets in patients with chronic kidney disease: MDRD and AASK now confirming SPRINT

2020 ◽  
Author(s):  
Pantelis Sarafidis ◽  
Charalampos Loutradis ◽  
Alberto Ortiz ◽  
Luis M Ruilope
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Systolic Blood Pressure ◽  
Recent Analysis ◽  
Intervention Trial ◽  
Mortality Benefit ◽  
Blood Pressure Targets ◽  
Hypertension Guidelines ◽  
All Cause Mortality

Abstract Recent American and European hypertension guidelines are not in agreement regarding blood pressure (BP) targets for persons with chronic kidney disease (CKD). Previous analyses from the African American Study on Kidney Disease (AASK) and Modification of Diet in Renal Disease (MDRD) trials suggested that strict BP control confers nephroprotection for patients with proteinuria, but a mortality benefit was not apparent. In contrast, an analysis of the Systolic Blood Pressure Intervention Trial (SPRINT) subpopulation of CKD patients showed a mortality benefit with the systolic blood pressure (SBP) &lt;120 mmHg versus the SBP &lt;140 target. A recent analysis of the combined MDRD and AASK cohorts supports previous evidence on nephroprotection but also findings from the SPRINT trial on all-cause mortality benefits of intensive versus usual BP control in individuals with CKD.

scholarly journals Chronic Kidney Disease Classification in Systolic Blood Pressure Intervention Trial: Comparison Using Modification of Diet in Renal Disease and CKD-Epidemiology Collaboration Definitions

2016 ◽  
Vol 44 (2) ◽  
pp. 130-140 ◽  
Author(s):  
Michael V. Rocco ◽  
Arlene Chapman ◽  
Glenn M. Chertow ◽  
Debbie Cohen ◽  
Jing Chen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Disease ◽  
Systolic Blood Pressure ◽  
Disease Classification ◽  
Intervention Trial ◽  
Mdrd Equation ◽  
Ckd Stage ◽  
Lower Egfr

Background: Interventional trials have used either the Modification of Diet in Renal Disease (MDRD) or chronic kidney disease (CKD)-Epidemiology Collaboration (CKD-EPI) equation for determination of estimated glomerular filtration rate (eGFR) to define whether participants have stages 3-5 CKD. The equation used to calculate eGFR may influence the number and characteristics of participants designated as having CKD. Methods: We examined the classification of CKD at baseline using both equations in the Systolic Blood Pressure Intervention Trial (SPRINT). eGFR was calculated at baseline using fasting serum creatinine values from a central laboratory. Results: Among 9,308 participants with baseline CKD classification using the 4-variable MDRD equation specified in the SPRINT protocol, 681 (7.3%) participants were reclassified to a less advanced CKD stage (higher eGFR) and 346 (3.7%) were reclassified to a more advanced CKD stage (lower eGFR) when the CKD-EPI equation was used to calculate eGFR. For eGFRs <90 ml/min/1.73 m2, participants <75 years were more likely to be reclassified to a less advanced CKD stage; this reclassification was more likely to occur in non-blacks rather than blacks. Participants aged ≥75 years were more likely to be reclassified to a more advanced than a less advanced CKD stage, regardless of baseline CKD stage. Reclassification of baseline CKD status (eGFR <60 ml/min/1.73 m2) occurred in 3% of participants. Conclusions: Use of the MDRD equation led to a higher percentage of participants being classified as having CKD stages 3-4. Younger and non-black participants were more likely to be reclassified as not having CKD using the CKD-EPI equation.

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