Effect of Intensive Blood Pressure Control on Kidney Outcomes: Long-Term Electronic Health Record-Based Post-Trial Follow-Up of SPRINT.
In long-term EHR-based follow-up of SPRINT, intensive blood pressure control caused a steeper decline in eGFR and more kidney events during the trial's active phase, but these adverse kidney effects did not persist after the intervention period ended.
Background
The Systolic Blood Pressure Intervention Trial (SPRINT) compared a systolic BP goal of less than 120 mm Hg (intensive) with less than 140 mm Hg (standard) in patients with hypertension and elevated cardiovascular risk. Intensive lowering was known to produce acute decreases in kidney function and a higher risk of acute kidney injury, raising the question of whether these effects translate into lasting harm to the kidney.
Study design
Investigators linked SPRINT trial data with outpatient electronic health record creatinine values from 49 of 102 study sites, capturing a median of about 8.3 years of follow-up in 3041 participants. They estimated the total slope of eGFR decline during the intervention phase and the slope during the post-trial observation phase, alongside categorical kidney endpoints such as a 30 percent or greater decline in eGFR.
Key findings
During the intervention phase, the eGFR slope was steeper in the intensive group (-0.96 ml/min per 1.73 m2 per year) than in the standard group (-0.67 ml/min per 1.73 m2 per year). The slopes were no longer significantly different during the post-trial observation phase. Among participants without baseline CKD, intensive treatment carried a higher risk of a 30 percent or greater eGFR decline during the intervention (hazard ratio 3.27) but not afterward.
Clinical implications
The kidney-function decline and excess kidney events associated with intensive BP control appear to be largely confined to the active treatment period rather than reflecting progressive long-term injury. These data are reassuring that the eGFR reductions seen with intensive targets are predominantly hemodynamic, though clinicians should still monitor kidney function closely when intensifying antihypertensive therapy.
Category
Research
Source
Clin J Am Soc Nephrol
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