Intensive systolic blood pressure reduction and kidney and cardiovascular outcomes (CRHCP secondary analysis)
In a large community-based trial in rural China, lowering blood pressure to under 130/80 with help from non-physician health workers reduced heart and stroke events without increasing kidney injury in people who did not already have chronic kidney disease.
Background
Intensive blood pressure control reduces major cardiovascular events, but whether lowering systolic BP causes kidney injury remains controversial, especially in people without pre-existing chronic kidney disease.
Study design
This secondary analysis of the China Rural Hypertension Control Project (CRHCP), an open-label, blinded-endpoint cluster randomized trial in 326 villages, included 33,332 patients with baseline eGFR >=60 mL/min/1.73m2. Non-physician community health professionals implemented an intervention targeting BP <130/80 mm Hg versus usual care.
Key findings
After 36 months, among 7,562 participants with eGFR 60-90, the kidney outcome (eGFR decrease of 30% to <60) occurred in 121 (intervention) versus 101 (usual care) (risk ratio 1.17, 95% CI 0.82-1.62; P=.36, not significant). The composite cardiovascular outcome occurred in 2.0% per year (intervention) versus 3.3% per year (usual care) (HR 0.57, 95% CI 0.47-0.68; P<.001).
Clinical implications
The findings support implementing intensive BP control in patients without chronic kidney disease, suggesting cardiovascular benefit without increased risk of kidney injury in this population.
Category
Research
Source
JAMA Network Open
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