Intensive Blood-Pressure Control in Hypertensive Chronic Kidney Disease
By L. Appel, J. Wright, Tom Greene, L. Agodoa, B. Astor, G. Bakris, W. Cleveland, J. Charleston, G. Contreras, M. Faulkner and 20 more. New England Journal of Medicine, 2010
688 citations recorded by the source corpus.
BACKGROUND In observational studies, the relationship between blood pressure and end-stage renal disease (ESRD) is direct and progressive. The burden of hypertension-related chronic kidney disease and ESRD is especially high among black patients. Yet few trials have tested whether intensive blood-pressure control retards the progression of chronic kidney disease among black patients. METHODS We randomly assigned 1094 black patients with hypertensive chronic kidney disease to receive either intensive or standard blood-pressure control. After completing the trial phase, patients were invited to enroll in a cohort phase in which the blood-pressure target was less than 130/80 mm Hg. The primary clinical outcome in the cohort phase was the progression of chronic kidney disease, which was defined as a doubling of the serum creatinine level, a diagnosis of ESRD, or death. Follow-up ranged from 8.8 to 12.2 years. RESULTS During the trial phase, the mean blood pressure was 130/78 mm Hg in the intensive-control group and 141/86 mm Hg in the standard-control group. During the cohort phase, corresponding mean blood pressures were 131/78 mm Hg and 134/78 mm Hg. In both phases, there was no significant between-group difference in the risk of the primary outcome (hazard ratio in the intensive-control group, 0.91; P = 0.27). However, the effects differed according to the baseline level of proteinuria (P = 0.02 for interaction), with a potential benefit in patients with a protein-to-creatinine ratio of more than 0.22 (hazard ratio, 0.73; P = 0.01). CONCLUSIONS In overall analyses, intensive blood-pressure control had no effect on kidney disease progression. However, there may be differential effects of intensive blood-pressure control in patients with and those without baseline proteinuria. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases, the National Center on Minority Health and Health Disparities, and others.)
Subfields: Cardiology and Cardiovascular Medicine, Nephrology, Nutrition and Dietetics
View Paper: https://www.semanticscholar.org/paper/8e129872bc3b54c710bb76ead39b162d94ca1727
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In Cardiology and Cardiovascular Medicine
Citations in the corpus
- The 2015 Canadian Hypertension Education Program recommendations for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension. (2013, background): “3), these observational data are not supported by the results of three trials in which CKD patients were randomized to a lower (<125– 130 mmHg) or higher (<140 mmHg) BP target [304–306]: no difference in renal failure or death was found between the two arms, except in the observational follow-up of ”
- Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis. (2016, background): “Results Search Results and Characteristics of Included Studies The literature search yielded 1,650 articles of which 67 were reviewed in full text and from which 15 randomized controlled trials reported in 17 publications were identified (Figure 1) [16– 18,22–35].”
- ESH / ESC Guidelines for the management of arterial hypertension (2013, result): “3), these observational data are not supported by the results of three trials in which CKD patients were randomized to a lower (,125–130 mmHg) or higher (,140 mmHg) BP target: 304 – 306 no difference in renal failure or death was found between the two arms, except in the observational follow-up of t”