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Updated: Feb 19, 2026
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
BP Reduction, Kidney Function Decline, and Cardiovascular Events in Patients without CKD
Rita Magriço1, Miguel Bigotte Vieira2, Catarina Viegas Dias3
1Masters in Medicine, Nephrology Department, Hospital Garcia de Orta, Lisbon, Portugal.
Insights
Intensive blood pressure treatment in SPRINT showed benefits but increased kidney function decline risk with greater mean arterial pressure reduction. Greater reduction was linked to higher kidney harm, suggesting careful consideration for intensive BP targets.
Area of Science:
- Cardiology
- Nephrology
- Clinical Trials
Background:
- The Systolic Blood Pressure Intervention Trial (SPRINT) compared intensive systolic blood pressure (BP) treatment (<120 mm Hg) to standard treatment (<140 mm Hg).
- Intensive treatment reduced cardiovascular events but increased kidney function decline.
- This study focuses on patients without chronic kidney disease (CKD).
Purpose of the Study:
- To evaluate the association between mean arterial pressure (MAP) reduction, kidney function decline, and cardiovascular events in SPRINT participants without CKD.
- To determine the risks and benefits of intensive BP lowering based on MAP reduction levels.
Main Methods:
- Patients in the intensive treatment group were categorized by MAP reduction (<20, 20 to <40, ≥40 mm Hg).
- Kidney function decline was defined as a ≥30% reduction in eGFR to <60 ml/min/1.73 m².
- Cardiovascular events were secondary outcomes.
- Propensity score matching compared intensive vs. standard treatment groups.
Main Results:
- In the intensive group, 34% had MAP reduction <20 mm Hg, 56% had 20 to <40 mm Hg, and 9% had ≥40 mm Hg.
- Adjusted hazard ratios for kidney function decline increased with greater MAP reduction (2.10 for 20-40 mm Hg, 6.22 for ≥40 mm Hg).
- Number needed to harm for kidney decline was 16 for MAP reduction ≥40 mm Hg, while number needed to treat for cardiovascular events was 95.
Conclusions:
- Greater MAP reduction in the intensive treatment arm of SPRINT was associated with a higher incidence of kidney function decline.
- Intensive BP treatment may be less favorable when substantial MAP reduction is required to achieve target BP goals, particularly concerning kidney health.
Background And Objectives:
In the Systolic Blood Pressure Intervention Trial (SPRINT), intensive systolic BP treatment (target <120 mm Hg) was associated with fewer cardiovascular events and higher incidence of kidney function decline compared with standard treatment (target <140 mm Hg). We evaluated the association between mean arterial pressure reduction, kidney function decline, and cardiovascular events in patients without CKD.
Design, Setting, Participants, & Measurements:
We categorized patients in the intensive treatment group of the SPRINT according to mean arterial pressure reduction throughout follow-up: <20, 20 to <40, and ≥40 mm Hg. We defined the primary outcome as kidney function decline (≥30% reduction in eGFR to <60 ml/min per 1.73 m2 on two consecutive determinations at 3-month intervals), and we defined the secondary outcome as cardiovascular events. In a propensity score analysis, patients in each mean arterial pressure reduction category from the intensive treatment group were matched with patients from the standard treatment group to calculate the number needed to treat regarding cardiovascular events and the number needed to harm regarding kidney function decline.
Results:
In the intensive treatment group, 1138 (34%) patients attained mean arterial pressure reduction <20 mm Hg, 1857 (56%) attained 20 to <40 mm Hg, and 309 (9%) attained ≥40 mm Hg. Adjusted hazard ratios for kidney function decline were 2.10 (95% confidence interval, 1.22 to 3.59) for mean arterial pressure reduction between 20 and 40 mm Hg and 6.22 (95% confidence interval, 2.75 to 14.08) for mean arterial pressure reduction ≥40 mm Hg. In propensity score analysis, mean arterial pressure reduction <20 mm Hg presented a number needed to treat of 44 and a number needed to harm of 65, reduction between 20 and <40 mm Hg presented a number needed to treat of 42 and a number needed to harm of 35, and reduction ≥40 mm Hg presented a number needed to treat of 95 and a number needed to harm of 16.
Conclusions:
In the intensive treatment group of SPRINT, larger declines in mean arterial pressure were associated with higher incidence of kidney function decline. Intensive treatment seemed to be less favorable when a larger reduction in mean arterial pressure was needed to attain the BP target.
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