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BP Control and Long-Term Risk of ESRD and Mortality

Elaine Ku, Jennifer Gassman, Lawrence J. Appel, Miroslaw Smogorzewski, Mark J. Sarnak, David V. Glidden, George Bakris, Orlando M. Gutiérrez, Lee A. Hebert, Joachim H. Ix, Janice Lea, Michael S. Lipkowitz, Keith Norris, David Ploth, Velvie A. Pogue, Stephen G. Rostand, Edward D. Siew, Mohammed Sika, C. Craig Tisher, Robert Toto, Jackson T. Wright, Christina Wyatt and Chi-yuan Hsu
JASN February 2017, 28 (2) 671-677; DOI: https://doi.org/10.1681/ASN.2016030326
Elaine Ku
*Department of Medicine, Division of Nephrology,
†Department of Pediatrics, Division of Pediatric Nephrology, and
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Jennifer Gassman
‡Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio;
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Lawrence J. Appel
§Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland;
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Miroslaw Smogorzewski
‖Department of Medicine, Division of Nephrology and Hypertension, University of Southern California, Los Angeles, California;
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Mark J. Sarnak
¶Department of Medicine, Division of Nephrology, Tufts Medical Center, Boston, Massachusetts;
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David V. Glidden
**Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California;
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George Bakris
††Department of Medicine, Comprehensive Hypertension Center, University of Chicago Medicine, Chicago, Illinois;
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Orlando M. Gutiérrez
‡‡Departments of Medicine and
§§Epidemiology, Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama;
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Lee A. Hebert
‖‖Department of Internal Medicine, Division of Nephrology, Ohio State University, Columbus, Ohio;
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Joachim H. Ix
¶¶Department of Medicine, Division of Nephrology, University of California, San Diego, San Diego, California;
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Janice Lea
***Department of Medicine, Division of Renal Medicine, Emory University, Atlanta, Georgia;
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Michael S. Lipkowitz
†††Department of Medicine, Division of Nephrology, Georgetown University, Washington DC;
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Keith Norris
‡‡‡Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, Los Angeles, California;
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David Ploth
§§§Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, South Carolina;
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Velvie A. Pogue
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Stephen G. Rostand
‡‡Departments of Medicine and
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Edward D. Siew
‖‖‖Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt Center for Kidney Disease, Vanderbilt University Medical Center, Nashville, Tennessee;
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Mohammed Sika
‖‖‖Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt Center for Kidney Disease, Vanderbilt University Medical Center, Nashville, Tennessee;
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C. Craig Tisher
¶¶¶Department of Medicine, Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, Florida;
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Robert Toto
****Department of Internal Medicine, Division of Nephrology, University of Texas Southwestern Medical Center, Dallas, Texas;
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Jackson T. Wright Jr.
††††Department of Internal Medicine, Division of Nephrology and Hypertension, Case Western Reserve University, Cleveland, Ohio; and
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Christina Wyatt
‡‡‡‡Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, New York
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Chi-yuan Hsu
*Department of Medicine, Division of Nephrology,
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Abstract

We recently showed an association between strict BP control and lower mortality risk during two decades of follow-up of prior participants in the Modification of Diet in Renal Disease (MDRD) trial. Here, we determined the risk of ESRD and mortality during extended follow-up of the African American Study of Kidney Disease and Hypertension (AASK) trial. We linked 1067 former AASK participants with CKD previously randomized to strict or usual BP control (mean arterial pressure ≤92 mmHg or 102–107 mmHg, respectively) to the US Renal Data System and Social Security Death Index; 397 patients had ESRD and 475 deaths occurred during a median follow-up of 14.4 years from 1995 to 2012. Compared with the usual BP arm, the strict BP arm had unadjusted and adjusted relative risks of ESRD of 0.92 (95% confidence interval [95% CI], 0.75 to 1.12) and 0.95 (95% CI, 0.78 to 1.16; P=0.64), respectively, and unadjusted and adjusted relative risks of death of 0.92 (95% CI, 0.77 to 1.10) and 0.81 (95% CI, 0.68 to 0.98; P=0.03), respectively. In meta-analyses of individual-level data from the MDRD and the AASK trials, unadjusted relative risk of ESRD was 0.88 (95% CI, 0.78 to 1.00) and unadjusted relative risk of death was 0.87 (95% CI, 0.76 to 0.99) for strict versus usual BP arms. Our findings suggest that, during long–term follow-up, strict BP control does not delay the onset of ESRD but may reduce the relative risk of death in CKD.

  • hypertension
  • ckd
  • ESRD
  • Copyright © 2017 by the American Society of Nephrology
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Journal of the American Society of Nephrology: 28 (2)
Journal of the American Society of Nephrology
Vol. 28, Issue 2
February 2017
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BP Control and Long-Term Risk of ESRD and Mortality
Elaine Ku, Jennifer Gassman, Lawrence J. Appel, Miroslaw Smogorzewski, Mark J. Sarnak, David V. Glidden, George Bakris, Orlando M. Gutiérrez, Lee A. Hebert, Joachim H. Ix, Janice Lea, Michael S. Lipkowitz, Keith Norris, David Ploth, Velvie A. Pogue, Stephen G. Rostand, Edward D. Siew, Mohammed Sika, C. Craig Tisher, Robert Toto, Jackson T. Wright, Christina Wyatt, Chi-yuan Hsu
JASN Feb 2017, 28 (2) 671-677; DOI: 10.1681/ASN.2016030326

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BP Control and Long-Term Risk of ESRD and Mortality
Elaine Ku, Jennifer Gassman, Lawrence J. Appel, Miroslaw Smogorzewski, Mark J. Sarnak, David V. Glidden, George Bakris, Orlando M. Gutiérrez, Lee A. Hebert, Joachim H. Ix, Janice Lea, Michael S. Lipkowitz, Keith Norris, David Ploth, Velvie A. Pogue, Stephen G. Rostand, Edward D. Siew, Mohammed Sika, C. Craig Tisher, Robert Toto, Jackson T. Wright, Christina Wyatt, Chi-yuan Hsu
JASN Feb 2017, 28 (2) 671-677; DOI: 10.1681/ASN.2016030326
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