• Srinivasan Beddhu, Michael V Rocco, Robert Toto, Timothy E Craven, Tom Greene, Udayan Bhatt, Alfred K Cheung, Debbie Cohen, Barry I Freedman, Amret T Hawfield, Anthony A Killeen, Paul L Kimmel, James Lash, Vasilios Papademetriou, Mahboob Rahman, Anjay Rastogi, Karen Servilla, Raymond R Townsend, Barry Wall, Paul K Whelton, and SPRINT Research Group.
• From University of Utah School of Medicine, Salt Lake City, Utah; Wake Forest School of Medicine, Winston-Salem, North Carolina; University of Texas Southwestern Medical Center, Dallas, Texas; Ohio State University, Columbus, Ohio; University of Pennsylvania, Philadelphia, Pennsylvania; University of Minnesota, Minneapolis, Minnesota; National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland; University of Illinois at Chicago, Chicago, Illinois; VA Medical Center, Washington, DC; Case Western Reserve University, Cleveland, Ohio; University of California, Los Angeles, Los Angeles, California; VA Medical Center, Albuquerque, New Mexico; VA Medical Center, Memphis, Tennessee; and Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.
• Ann. Intern. Med. 2017 Sep 19; 167 (6): 375-383.

BackgroundThe public health significance of the reported higher incidence of chronic kidney disease (CKD) with intensive systolic blood pressure (SBP) lowering is unclear.ObjectiveTo examine the effects of intensive SBP lowering on kidney and cardiovascular outcomes and contrast its apparent beneficial and adverse effects.DesignSubgroup analyses of SPRINT (Systolic Blood Pressure Intervention Trial). (ClinicalTrials.gov: NCT01206062).SettingAdults with high blood pressure and elevated cardiovascular risk.Participants6662 participants with a baseline estimated glomerular filtration rate (eGFR) of at least 60 mL/min/1.73 m2.InterventionRandom assignment to an intensive or standard SBP goal (120 or 140 mm Hg, respectively).MeasurementsDifferences in mean eGFR during follow-up (estimated with a linear mixed-effects model), prespecified incident CKD (defined as a >30% decrease in eGFR to a value <60 mL/min/1.73 m2), and a composite of all-cause death or cardiovascular event, with surveillance every 3 months.ResultsThe difference in adjusted mean eGFR between the intensive and standard groups was -3.32 mL/min/1.73 m2 (95% CI, -3.90 to -2.74 mL/min/1.73 m2) at 6 months, was -4.50 mL/min/1.73 m2 (CI, -5.16 to -3.85 mL/min/1.73 m2) at 18 months, and remained relatively stable thereafter. An incident CKD event occurred in 3.7% of participants in the intensive group and 1.0% in the standard group at 3-year follow-up, with a hazard ratio of 3.54 (CI, 2.50 to 5.02). The corresponding percentages for the composite of death or cardiovascular event were 4.9% and 7.1% at 3-year follow-up, with a hazard ratio of 0.71 (CI, 0.59 to 0.86).LimitationLong-term data were lacking.ConclusionIntensive SBP lowering increased risk for incident CKD events, but this was outweighed by cardiovascular and all-cause mortality benefits.Primary Funding SourceNational Institutes of Health.

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