Intensive BP Treatment Linked With Possible Risk of Kidney Function Decline
NEW ORLEANS -- November 6, 2017 -- In individuals undergoing intensive blood pressure (BP) treatment, greater reductions in mean BP were linked with an increased risk of kidney function decline.
The findings were presented at Kidney Week 2017, the Annual Meeting of the American Society of Nephrology (ASN).
Rita Magriço, MD, Hospital Garcia de Orta, Almada, Portugal, and colleagues conducted an analysis of the SPRINT study and found that the increased risk to the kidneys was related to greater decreases in mean BP. The benefit-risk balance of intensive treatment was less favourable as average BP reduction increased.
“The fact that in our analysis the benefit-risk relationship became less favourable with greater mean blood pressure reductions may be important for patients and physicians as they aim for the lowest cardiovascular risk with the lowest probability of side effects,” said Dr. Magriço, “If this association is confirmed by prospective studies, future recommendations for hypertension treatment in this population should consider personalized targets rather than a fixed cut-off for every patient.”
The researchers categorised patients in the intensive treatment group of the SPRINT trial according to mean arterial pressure reduction throughout follow-up (<20, 20 to <40, and ≥40 mm Hg). The primary endpoint was kidney function decline (≥30% reduction in eGFR to <60 ml/min per 1.73 m2 on two consecutive determinations at 3-month intervals).
Results In the intensive treatment group, 1138 (34%) patients attained mean arterial pressure reduction <20 mm Hg, 1857 (56%) attained 20 to <40 mm Hg, and 309 (9%) attained ≥40 mm Hg.
Adjusted hazard ratios (HRs) for kidney function decline were 2.10 for mean arterial pressure reduction between 20 and 40 mm Hg and 6.22 for mean arterial pressure reduction ≥40 mm Hg.
In propensity score analysis, mean arterial pressure reduction <20 mm Hg presented a number needed to treat of 44 and a number needed to harm of 65, reduction between 20 and <40 mm Hg presented a number needed to treat of 42 and a number needed to harm of 35, and reduction ≥40 mm Hg presented a number needed to treat of 95 and a number needed to harm of 16.
SOURCE: American Society of Nephrology