For individuals with chronic kidney disease, strict blood pressure control may help protect against premature death. That’s the conclusion of a recent analysis of clinical trial data. The findings appear in an upcoming issue of the Journal of the American Society of Nephrology (JASN).
Blood pressure treatment targets are a subject of continued debate. Some recent clinical trials that followed participants for several years have shown that lowering systolic blood pressure to <120 mm Hg (which is lower than the currently recommended goal) is beneficial for heart health and longevity. On the other hand, some longer-term observational studies have suggested that lower blood pressure levels may be harmful.
To better examine the long-term health of individuals with chronic kidney disease who were exposed to a period of intensive blood pressure control, Elaine Ku, MD, MAS (University of California San Francisco) and her colleagues studied prior participants of 2 completed randomized controlled trials of intensive blood pressure lowering: the Modification of Diet in Renal Disease study and the African American Study of Kidney Disease and Hypertension. These studies have previously reported that intensive blood pressure lowering may not protect against kidney failure.
When they pooled the results of 2 decades of follow-up from these studies (including >1900 patients), the researchers found that having a lower blood pressure target than the currently guideline-recommended goal of 140/90 mm Hg was safe and associated with protection against premature death. Among the subset of CKD patients with higher levels of proteinuria, this strategy also protected against kidney failure.
“The data that we provide include outcomes beyond the typical duration of clinical trials of blood pressure control and demonstrate the long-term safety of tighter blood pressure control, with potential benefits from a mortality standpoint in patients with known kidney disease,” said Dr. Ku.
Study co-authors include Jennifer Gassman, PhD, Lawrence J. Appel, MD, Miroslaw Smogorzewski, MD,PhD, Mark J. Sarnak, MD, MS, David V. Glidden, PhD, George Bakris, MD, Orlando M. Gutiérrez, MD, MMSc, Lee A. Hebert, MD, Joachim H. Ix, MD, Janice Lea, MD, Michael S. Lipkowitz, MD, Keith Norris, MD, PhD, David Ploth, MD, Velvie A. Pogue, MD, Stephen G. Rostand, MD, Edward D. Siew, MD, MSCI, Mohammed Sika, MS, PhD, C. Craig Tisher, MD, Robert Toto, MD, Jackson T. Wright, Jr, MD, PhD, Christina Wyatt, MD, and Chi-yuan Hsu, MD, MSc.
Disclosures: The authors reported no financial disclosures.
The article, entitled “Blood Pressure Control and Long-term Risk of ESRD and Mortality,” will appear online at http://www.jasn.asnjournals.org/.
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