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Intensive Systolic Blood Pressure Lowering and Kidney Disease Progression in IgA Nephropathy: A Cohort Study

Guizhen Yu1,2,3,4,5, Jun Cheng1,2,3,4,5, Yan Jiang1,2,3,4,5

  • 1Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.

Frontiers in Medicine
|March 7, 2022
PubMed

Insights

Lowering systolic blood pressure (SBP) to below 120 mmHg in IgA nephropathy (IgAN) patients is renoprotective. This blood pressure target significantly reduces kidney failure events, especially in those with higher proteinuria.

Area of Science:

  • Nephrology
  • Cardiovascular Medicine
  • Clinical Research

Background:

  • Hypertension is a key risk factor for IgA nephropathy (IgAN) progression.
  • The 2021 KDIGO Guideline recommends a target systolic blood pressure (SBP) <120 mmHg for Chronic Kidney Disease (CKD) patients.
  • The renoprotective effect of lowering SBP from <140 to <120 mmHg in IgAN remains unclear.

Purpose of the Study:

  • To investigate the association between SBP and IgAN progression.
  • To determine if lowering SBP from <140 to <120 mmHg offers renoprotection in IgAN patients.

Main Methods:

  • Utilized Cox proportional hazards models and restricted cubic splines.
  • Analyzed data from 2,240 IgAN patients.
  • Defined kidney failure events as a 50% decline in estimated glomerular filtration rate (eGFR) or kidney failure.

Main Results:

  • A linear relationship was observed between higher SBP and increased risk of kidney failure events.
  • Patients with SBP <140 mmHg had a hazard ratio of 1.85 (1.16-2.97) for kidney failure compared to SBP <120 mmHg.
  • Renoprotective benefits were noted in subgroups with proteinuria >1.0 g/d and CKD stages 1-3a, but not in those with proteinuria ≤1.0 g/d and CKD stages 3b-4.

Conclusions:

  • SBP is an independent predictor of kidney failure events in IgAN patients.
  • Lowering SBP from <140 mmHg to <120 mmHg demonstrates renoprotective effects.
  • Therapeutic benefits of intensive SBP reduction are more pronounced in specific patient subgroups.
Abstract

Keywords:
IgA nephropathykidney failureproteinuriarenoprotectivesystolic blood pressure

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