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Relationship between blood pressure and kidney diseases in large randomized controlled trials: secondary analyses

Ling Wang1, Kevin Pezeshkian2, Supratik Rayamajhi3

  • 1Department of Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, USA. wangli35@msu.edu.

Journal of Human Hypertension
|October 23, 2020
PubMed

Insights

Lowering diastolic blood pressure (DBP) too much may harm kidney function in patients without chronic kidney disease (CKD). Optimal blood pressure targets are crucial for preventing acute kidney injury in diverse patient groups.

Area of Science:

  • Nephrology
  • Cardiology
  • Clinical Trials

Background:

  • Hypertension is a significant risk factor for acute kidney injury.
  • Determining optimal blood pressure (BP) targets is essential for managing kidney disease and preventing adverse renal outcomes.
  • Previous studies suggest a complex relationship between BP and renal health, necessitating further investigation into specific patient populations.

Purpose of the Study:

  • To identify optimal systolic blood pressure (SBP) and diastolic blood pressure (DBP) targets for patients with and without chronic kidney disease (CKD).
  • To investigate the nonlinear relationship between BP and the development of renal disease.
  • To assess the risk of adverse renal outcomes associated with different BP management strategies.

Main Methods:

  • Analysis of data from the Systolic Blood Pressure Intervention Trial (SPRINT) and the Action to Control Cardiovascular Risk in Diabetes Blood Pressure trial (ACCORD BP).
  • Utilized Generalized Additive Models (GAM) to determine the nonlinear relationship between BP and renal disease development.
  • Employed logistic regression to calculate odds ratios (ORs) for adverse renal outcomes across high, medium, and low BP groups.

Main Results:

  • Both SPRINT and ACCORD BP trials revealed a 'U'-shaped relationship between BP and renal outcomes, indicating risks at both high and low BP levels.
  • In non-CKD patients, intensive BP management with DBP ≤ 70 mmHg was associated with significantly higher risks of reduced estimated glomerular filtration rate (eGFR) in SPRINT (OR=2.31) and doubled serum creatinine (SCr) or >20 mL/min decrease in eGFR in ACCORD BP (OR=1.49) compared to DBP 71-85 mmHg.
  • No significant differences in renal outcomes were observed for CKD patients across different SBP/DBP levels in the SPRINT trial.

Conclusions:

  • Lower-than-optimal DBP levels can contribute to adverse renal outcomes, particularly in non-CKD patients.
  • Healthcare providers should exercise caution regarding excessively low DBP targets during intensive BP management to mitigate risks of kidney injury in non-CKD individuals.
  • The findings underscore the importance of individualized BP targets, considering renal status, to optimize patient outcomes and prevent acute kidney injury.

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