Intensive blood-pressure control in hypertensive chronic kidney disease

Area of Science:

• Nephrology
• Cardiovascular Medicine
• Clinical Trials

Background:

• Hypertension and end-stage renal disease (ESRD) share a direct, progressive relationship.
• Black patients bear a disproportionately high burden of hypertension-related chronic kidney disease (CKD) and ESRD.
• Limited trials have investigated intensive blood pressure control's efficacy in slowing CKD progression in this demographic.

Purpose of the Study:

• To evaluate the effect of intensive blood pressure control on CKD progression in black patients.
• To determine if baseline proteinuria influences the efficacy of intensive blood pressure control.

Main Methods:

• Randomized trial of 1094 black patients with hypertensive CKD assigned to intensive or standard blood pressure control.
• Follow-up included a trial phase and a subsequent cohort phase with a target BP < 130/80 mm Hg.
• Primary outcome: CKD progression (doubled creatinine, ESRD, or death), with 8.8–12.2 years of follow-up.

Main Results:

• No significant difference in primary outcome between intensive and standard BP control groups overall (HR, 0.91; P=0.27).
• Mean BP was 130/78 mm Hg (intensive) vs. 141/86 mm Hg (standard) in trial phase.
• Mean BP was 131/78 mm Hg (intensive) vs. 134/78 mm Hg (standard) in cohort phase.
• Significant interaction with baseline proteinuria (P=0.02); intensive control showed potential benefit for proteinuria > 0.22 (HR, 0.73; P=0.01).

Conclusions:

• Intensive blood pressure control did not significantly impact overall kidney disease progression in this cohort.
• Potential differential benefits of intensive BP control may exist for patients with higher baseline proteinuria.
• Further research is warranted to explore targeted BP management strategies based on proteinuria levels.