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Low Achieved Systolic Blood Pressure Related to Kidney Protection in Diabetic and Non-Diabetic High-Risk Hypertensive
Eirik Olsen1,2, Camilla L Søraas3,4, Roland E Schmieder5
1Norwegian University of Science and Technology, Trondheim, Norway.
Insights
Lowering systolic blood pressure (SBP) to 130-139 mmHg protects kidneys in high-risk hypertensive patients. Even lower SBP targets (<130 mmHg) may offer additional kidney benefits, regardless of diabetes status.
Area of Science:
- Nephrology
- Cardiology
- Hypertension Management
Background:
- The role of lowering systolic blood pressure (SBP) in protecting kidneys of hypertensive patients remains debated.
- This study investigated the kidney-protective effects of achieving lower SBP in middle-aged and older high-risk hypertensive patients, with and without type-2 diabetes mellitus.
Purpose of the Study:
- To determine if achieving lower average SBP over several years offers kidney protection in high-risk hypertensive patients.
- To clarify the impact of different SBP targets on kidney function and end-stage kidney disease (ESKD) risk.
Main Methods:
- Analysis of 13,803 patients (50-80 years) with hypertension, randomized to valsartan or amlodipine.
- Comparison of worsened kidney function (50% rise in serum creatinine or ESKD) based on achieved SBP levels (<130 mmHg, 130-139 mmHg, and ≥140 mmHg).
- Adjusted Cox analyses were used to compare outcomes in patients with and without type-2 diabetes mellitus (DM).
Main Results:
- Patients with DM achieving SBP 130-139 mmHg or <130 mmHg showed significantly less worsened kidney function compared to those with SBP ≥140 mmHg.
- Lower SBP targets were associated with reduced risk of end-stage kidney disease (ESKD) in patients with DM.
- Similar kidney protection trends were observed in patients without DM, indicating consistent benefits across groups.
Conclusions:
- Targeting SBP of 130-139 mmHg provides significant kidney protection in high-risk hypertensive patients aged 50-80, with or without diabetes.
- Achieving SBP <130 mmHg may offer further kidney protective benefits.
- These findings support intensified blood pressure management for renal protection in this patient population.
Background:
Protecting the kidneys by lowering systolic blood pressure (SBP) in hypertensive patients is not unequivocally settled. We tested the hypothesis that achieving lower average SBP in middle-aged and older high-risk hypertensive patients with and without type-2 diabetes mellitus through several years would clarify kidney protection.
Methods:
We analyzed patients 50-80 years with no cardiovascular events during the first 6 months of drug up-titration after randomization to valsartan or amlodipine, and with 3 or more visits onwards with standardized BP measurements. Adjusted Cox analyzes compared worsened kidney function defined as a 50% rise in se-creatinine on a minimum of two occasions at least 4 weeks apart or end-stage kidney disease (ESKD) in achieved SBP quartiles and in patients who achieved SBP < 130 and 130-139 mmHg with patients whose SBP remained ≥140 mmHg.
Results:
A total of 13,803 patients were investigated of whom 4,655 had DM. Patients with DM had less worsened kidney function at SBP 130-139 mmHg (HR = 0.524, 95% CIs 0.375-0.733, n = 1849, P < 0.001) and at SBP < 130 mmHg (HR = 0.538, CIs 0.316-0.915, n = 674, P = 0.022) compared with patients at ≥ 140 mmHg. They also had less ESKD at SBP 130-139 mmHg (HR = 0.442, CIs 0.196-1.000, P = 0.050) with a similar trend at SBP < 130 mmHg and in quartile analysis with only 1 ESKD in the lowest quartile. Findings in patients without DM (n = 9,148) were similar to DM.
Conclusions:
In high-risk hypertensive patients aged 50-80 years, with and without DM, targeting SBP of 130-139 mmHg confers kidney protection with possible further benefit at the lower target of SBP < 130 mmHg.
Clinical Trials Registration:
Trial Number NCT06395194, www.clinicaltrials.gov.
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