Effects of Intensive BP Control in CKD
Alfred K. Cheung,Mahboob Rahman,Mahboob Rahman,David M. Reboussin,Timothy E. Craven,Tom Greene,Paul L. Kimmel,William C. Cushman,Amret T. Hawfield,Karen C. Johnson,Cora E. Lewis,Suzanne Oparil,Michael V. Rocco,Kaycee M. Sink,Paul K. Whelton,Jackson T. Wright,Jan Basile,Jan Basile,Srinivasan Beddhu,Udayan Bhatt,Tara I. Chang,Glenn M. Chertow,Michel Chonchol,Barry I. Freedman,William E. Haley,Joachim H. Ix,Lois A. Katz,Lois A. Katz,Anthony A. Killeen,Vasilios Papademetriou,Ana C. Ricardo,Karen S. Servilla,Barry M. Wall,Barry M. Wall,Dawn F. Wolfgram,Jerry Yee +35 more
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TLDR
Among patients with CKD and hypertension without diabetes, targeting an SBP<120 mm Hg compared with <140mm Hg reduced rates of major cardiovascular events and all-cause death without evidence of effect modifications by CKD or deleterious effect on the main kidney outcome.Abstract:
The appropriate target for BP in patients with CKD and hypertension remains uncertain. We report prespecified subgroup analyses of outcomes in participants with baseline CKD in the Systolic Blood Pressure Intervention Trial. We randomly assigned participants to a systolic BP target of <120 mm Hg (intensive group; n=1330) or <140 mm Hg (standard group; n=1316). After a median follow-up of 3.3 years, the primary composite cardiovascular outcome occurred in 112 intensive group and 131 standard group CKD participants (hazard ratio [HR], 0.81; 95% confidence interval [95% CI], 0.63 to 1.05). The intensive group also had a lower rate of all-cause death (HR, 0.72; 95% CI, 0.53 to 0.99). Treatment effects did not differ between participants with and without CKD (P values for interactions ≥0.30). The prespecified main kidney outcome, defined as the composite of ≥50% decrease in eGFR from baseline or ESRD, occurred in 15 intensive group and 16 standard group participants (HR, 0.90; 95% CI, 0.44 to 1.83). After the initial 6 months, the intensive group had a slightly higher rate of change in eGFR (-0.47 versus -0.32 ml/min per 1.73 m2 per year; P<0.03). The overall rate of serious adverse events did not differ between treatment groups, although some specific adverse events occurred more often in the intensive group. Thus, among patients with CKD and hypertension without diabetes, targeting an SBP<120 mm Hg compared with <140 mm Hg reduced rates of major cardiovascular events and all-cause death without evidence of effect modifications by CKD or deleterious effect on the main kidney outcome.read more
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Journal ArticleDOI
A Randomized Trial of Intensive versus Standard Blood-Pressure Control
Jackson T. Wright,Jeff D. Williamson,Paul K. Whelton,Joni K. Snyder,Kaycee M. Sink,Michael V. Rocco,David M. Reboussin,Mahboob Rahman,Mahboob Rahman,Suzanne Oparil,Cora E. Lewis,Paul L. Kimmel,Karen C. Johnson,David C. Goff,Lawrence J. Fine,Jeffrey A. Cutler,William C. Cushman,Alfred K. Cheung,Walter T. Ambrosius +18 more
TL;DR: In this article, the most appropriate targets for systolic blood pressure to reduce cardiovascular morbidity and mortality among persons without diabetes remain uncertain, and the authors propose a target of less than 120 mm Hg.
Journal ArticleDOI
Effects of intensive blood-pressure control in type 2 diabetes mellitus.
C. Cushman,Gregory W. Evans,Robert P. Byington,Jeffrey A. Cutler,Denise G. Simons-Morton,Jan Basile,Jeffrey L. Probstfield,Lois A. Katz,Kevin A. Peterson,William T. Friedewald,John B. Buse,J. Thomas Bigger,Hertzel C. Gerstein +12 more
TL;DR: In patients with type 2 diabetes at high risk for cardiovascular events, targeting a systolic blood pressure of less than 120 mm HG, as compared with less than 140 mm Hg, did not reduce the rate of a composite outcome of fatal and nonfatal major cardiovascular events.
Journal ArticleDOI
A Randomized Trial of Intensive versus Standard Blood-Pressure Control.
TL;DR: Among patients at high risk for cardiovascular events but without diabetes, targeting a systolic blood pressure target of less than 120 mm Hg, as compared with less than 140 mm HG, resulted in lower rates of fatal and nonfatal major cardiovascular events and death from any cause, although significantly higher rates of some adverse events were observed in the intensive-treatment group.
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