BP Control and Long-Term Risk of ESRD and Mortality.

Area of Science:

• Nephrology
• Cardiovascular Medicine
• Clinical Trials

Background:

• Previous research indicated a link between strict blood pressure (BP) control and reduced mortality in Modification of Diet in Renal Disease (MDRD) trial participants.
• The African American Study of Kidney Disease and Hypertension (AASK) trial previously investigated BP control in patients with CKD.

Purpose of the Study:

• To evaluate the long-term risks of end-stage renal disease (ESRD) and mortality associated with strict versus usual BP control in AASK trial participants.
• To combine data with the MDRD trial for a meta-analysis on the effects of strict BP control on ESRD and mortality.

Main Methods:

• 1067 former AASK participants with CKD were linked to the US Renal Data System and Social Security Death Index.
• Participants were previously randomized to either strict (mean arterial pressure ≤92 mmHg) or usual (102-107 mmHg) BP control.
• Median follow-up was 14.4 years (1995-2012), with data on ESRD and mortality analyzed.

Main Results:

• Strict BP control showed no significant difference in the risk of ESRD compared to usual BP control (adjusted RR 0.95; P=0.64).
• Strict BP control was associated with a significantly lower risk of death (adjusted RR 0.81; P=0.03).
• Meta-analysis of AASK and MDRD data indicated a reduced risk of ESRD (RR 0.88) and death (RR 0.87) with strict BP control.

Conclusions:

• Strict BP control in CKD patients does not appear to delay the onset of ESRD.
• Long-term strict BP control may offer a survival benefit, reducing the relative risk of death in individuals with CKD.