Introduction:
Systolic Blood Pressure Intervention Trial (SPRINT) determined that among non-diabetic patients with increased CV risk, intensive management of systolic blood pressure (SBP) to a target of 120 mmHg resulted in lower rates of CV events and all-cause mortality, as opposed to the standard goal of 140 mmHg. Current management of BP in the CKD population shows conflicting evidence on target SBP. With the use of patient-level SPRINT data, our study investigates the risks and benefits of intensive BP management in patients with CKD at baseline and is the largest study of intensive BP management in CKD patients (n=2646).
Methods:
The similarity between CKD patients in standard and intensive blood pressure management groups with regard to age, race, gender, estimated GFR (eGFR), and baseline SBP were assessed and no differences were found between the two groups. Differences in mortality, adverse events, and rates of achieving BP targets in intensive and standard BP management groups were examined. Cox proportional-hazards models were used for the events analysis. Multiple linear regression was used to assess the differences in achieving BP targets.
Results and Discussion:
We highlight three key findings. First, the average post-management SBP was higher in CKD patients than in non-CKD patients in both standard (
p
= 0.017) and intensive (
p
< .001) groups, controlling for age, race, gender, eGFR, and baseline SBP, possibly indicating greater difficulty in controlling BP in CKD patients . Second, intensively-treated CKD patients had increased risks for intervention-related adverse events, including events that resulted in disability, hospitalization, or harm that may have required medical or surgical intervention (p < .001). They also experienced higher rates of AKI related adverse events (p<.008). Third, intensive management showed a mortality benefit (HR: .725; 95% CI, .532 to .987), a finding that may help clarify conflicting reports in current literature.
In conclusion, we present an analysis of CKD-specific SPRINT data in order to elucidate the clinical benefits and risks of intensive BP management in the CKD population.
Serious adverse events in patients with target-oriented blood pressure management
