Blood pressure in early autosomal dominant polycystic kidney disease

Area of Science:

• Nephrology
• Cardiology
• Clinical Trials

Background:

• Hypertension is a common complication of autosomal dominant polycystic kidney disease (ADPKD).
• Elevated blood pressure in ADPKD is linked to increased kidney volume and disease progression.
• Understanding optimal blood pressure management is crucial for ADPKD patients.

Purpose of the Study:

• To evaluate the impact of different blood pressure targets on kidney volume in hypertensive ADPKD patients.
• To assess the effect of dual renin-angiotensin-aldosterone system blockade versus monotherapy on ADPKD progression.
• To investigate the influence of blood pressure control on cardiovascular and renal markers.

Main Methods:

• A double-blind, placebo-controlled trial involving 558 hypertensive ADPKD patients (15-49 years, eGFR >60 ml/min/1.73 m²).
• Participants were randomized to standard (120/70-130/80 mmHg) or low (95/60-110/75 mmHg) blood pressure targets.
• Medication arms included lisinopril plus telmisartan or lisinopril plus placebo, with total kidney volume as the primary outcome.

Main Results:

• The low blood pressure target group showed a significantly lower annual increase in total kidney volume (5.6% vs. 6.6%, P=0.006).
• No significant difference in total kidney volume change was observed between the lisinopril-telmisartan and lisinopril-placebo groups.
• Rigorous blood pressure control led to greater reduction in left-ventricular mass index and urinary albumin excretion, with transient short-term decline in eGFR.

Conclusions:

• In early ADPKD, intensive blood pressure control slows total kidney volume increase compared to standard control.
• The combination of lisinopril and telmisartan did not offer additional benefit in reducing total kidney volume increase.
• Rigorous blood pressure management in ADPKD improves cardiovascular and renal markers without significant long-term impact on GFR.