Intensive BP control to prevent progression of hypertensive CKD?

January 01, 0001

Intensive BP control to prevent progression of hypertensive CKD?

In observational studies, the relationship between blood pressure and end-stage renal disease (ESRD) is direct and progressive. These US authors randomly assigned 1094 black patients with hypertensive chronic kidney disease to receive either intensive or standard blood-pressure control. After completing the trial phase, patients were invited to enroll in a cohort phase in which the blood-pressure target was less than 130/80 mm Hg. The primary clinical outcome in the cohort phase was the progression of chronic kidney disease, which was defined as a doubling of the serum creatinine level, a diagnosis of ESRD, or death. Follow-up ranged from 8.8 to 12.2 years.

They found: "During the trial phase, the mean blood pressure was 130/78 mm Hg in the intensive-control group and 141/86 mm Hg in the standard- control group. During the cohort phase, corresponding mean blood pressures were 131/78 mm Hg and 134/78 mm Hg. In both phases, there was no significant between-group difference in the risk of the primary outcome (hazard ratio in the intensive-control group, 0.91; NS). However, the effects differed according to the baseline level of proteinuria, with a potential benefit in patients with a protein-to-creatinine ratio of more than 0.22 (hazard ratio, 0.73; significant)."

The authors concluded: "In overall analyses, intensive blood- pressure control had no effect on kidney disease progression. However, there may be differential effects of intensive blood-pressure control in patients with and those without baseline proteinuria."

Tight blood pressure control is not does not prevent progression of hypertensive kidney disease to the degree that what was postulated based on observational data.

For the full abstract, click here.

N Engl J Med 363:918-929, 2 September 2010 © 2010 to the Massachusetts Medical Society
Intensive Blood-Pressure Control in Hypertensive Chronic Kidney Disease. Lawrence J. Appel, Jackson T. Wright, Tom Greene, et al. Correspondence to Dr. Appel: [email protected]

Category: U. Urinary System, K. Circulatory. Keywords: hypertension, chronic kidney disease, blood pressure control, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 14 September 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.