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Clinical Research
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Effects of Intensive BP Control in CKD

Alfred K. Cheung, Mahboob Rahman, David M. Reboussin, Timothy E. Craven, Tom Greene, Paul L. Kimmel, William C. Cushman, Amret T. Hawfield, Karen C. Johnson, Cora E. Lewis, Suzanne Oparil, Michael V. Rocco, Kaycee M. Sink, Paul K. Whelton, Jackson T. Wright, Jan Basile, Srinivasan Beddhu, Udayan Bhatt, Tara I. Chang, Glenn M. Chertow, Michel Chonchol, Barry I. Freedman, William Haley, Joachim H. Ix, Lois A. Katz, Anthony A. Killeen, Vasilios Papademetriou, Ana C. Ricardo, Karen Servilla, Barry Wall, Dawn Wolfgram and Jerry Yee; for the SPRINT Research Group
JASN September 2017, 28 (9) 2812-2823; DOI: https://doi.org/10.1681/ASN.2017020148
Alfred K. Cheung
*Division of Nephrology and Hypertension and
†Medical Service, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah;
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Mahboob Rahman
‡Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University Hospitals, Cleveland, Ohio;
§Department of Medicine, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio;
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David M. Reboussin
‖Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina;
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Timothy E. Craven
‖Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina;
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Tom Greene
¶Department of Population Health Sciences, University of Utah, Salt Lake City, Utah;
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Paul L. Kimmel
**Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland;
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William C. Cushman
††Hypertension Section, Medical Service and
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Amret T. Hawfield
‡‡Department of Internal Medicine, Section on Nephrology and
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Karen C. Johnson
§§Department of Preventive Medicine and
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Cora E. Lewis
‖‖Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama;
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Suzanne Oparil
¶¶Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama;
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Michael V. Rocco
‡‡Department of Internal Medicine, Section on Nephrology and
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Kaycee M. Sink
***Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina;
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Paul K. Whelton
†††Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana;
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Jackson T. Wright Jr.
‡Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University Hospitals, Cleveland, Ohio;
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Jan Basile
‡‡‡Department of Medicine, Medical University of South Carolina, Charleston, South Carolina;
§§§Primary Care Research, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina;
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Srinivasan Beddhu
*Division of Nephrology and Hypertension and
†Medical Service, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah;
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Udayan Bhatt
‖‖‖Division of Nephrology, Ohio State University Medical Center, Columbus, Ohio;
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Tara I. Chang
¶¶¶Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California;
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Glenn M. Chertow
¶¶¶Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California;
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Michel Chonchol
****Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado;
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Barry I. Freedman
‡‡Department of Internal Medicine, Section on Nephrology and
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William Haley
††††Division of Nephrology and Hypertension, Mayo Clinic Florida, Jacksonville, Florida;
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Joachim H. Ix
‡‡‡‡Division of Nephrology-Hypertension, Department of Medicine, University of California, San Diego, California;
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Lois A. Katz
§§§§Medical Service, Veterans Affairs New York Harbor Healthcare System, New York, New York;
‖‖‖‖Department of Medicine, New York University School of Medicine, New York, New York;
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Anthony A. Killeen
¶¶¶¶Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota;
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Vasilios Papademetriou
*****Division of Cardiology, Department of Medicine, Veterans Affairs Medical Center, Washington, DC;
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Ana C. Ricardo
†††††Department of Medicine, Division of Nephrology, University of Illinois, Chicago, Illinois;
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Karen Servilla
‡‡‡‡‡Renal Section, Medicine Service, New Mexico Veterans Affairs Health Care System, Albuquerque, New Mexico;
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Barry Wall
§§§§§Nephrology Section, Internal Medicine, Memphis Veterans Affairs Medical Center, Memphis, Tennessee;
‖‖‖‖‖Department of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee;
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Dawn Wolfgram
¶¶¶¶¶Section of Nephrology, Department of Medicine, Milwaukee Veterans Affairs Medical Center, Milwaukee, Wisconsin; and
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Jerry Yee
******Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, Michigan
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Abstract

The appropriate target for BP in patients with CKD and hypertension remains uncertain. We report prespecified subgroup analyses of outcomes in participants with baseline CKD in the Systolic Blood Pressure Intervention Trial. We randomly assigned participants to a systolic BP target of <120 mm Hg (intensive group; n=1330) or <140 mm Hg (standard group; n=1316). After a median follow-up of 3.3 years, the primary composite cardiovascular outcome occurred in 112 intensive group and 131 standard group CKD participants (hazard ratio [HR], 0.81; 95% confidence interval [95% CI], 0.63 to 1.05). The intensive group also had a lower rate of all-cause death (HR, 0.72; 95% CI, 0.53 to 0.99). Treatment effects did not differ between participants with and without CKD (P values for interactions ≥0.30). The prespecified main kidney outcome, defined as the composite of ≥50% decrease in eGFR from baseline or ESRD, occurred in 15 intensive group and 16 standard group participants (HR, 0.90; 95% CI, 0.44 to 1.83). After the initial 6 months, the intensive group had a slightly higher rate of change in eGFR (−0.47 versus −0.32 ml/min per 1.73 m2 per year; P<0.03). The overall rate of serious adverse events did not differ between treatment groups, although some specific adverse events occurred more often in the intensive group. Thus, among patients with CKD and hypertension without diabetes, targeting an SBP<120 mm Hg compared with <140 mm Hg reduced rates of major cardiovascular events and all-cause death without evidence of effect modifications by CKD or deleterious effect on the main kidney outcome.

  • blood pressure
  • chronic kidney disease
  • cardiovascular disease
  • glomerular filtration rate
  • hypertension
  • mortality
  • Copyright © 2017 by the American Society of Nephrology
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Journal of the American Society of Nephrology: 28 (9)
Journal of the American Society of Nephrology
Vol. 28, Issue 9
September 2017
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Effects of Intensive BP Control in CKD
Alfred K. Cheung, Mahboob Rahman, David M. Reboussin, Timothy E. Craven, Tom Greene, Paul L. Kimmel, William C. Cushman, Amret T. Hawfield, Karen C. Johnson, Cora E. Lewis, Suzanne Oparil, Michael V. Rocco, Kaycee M. Sink, Paul K. Whelton, Jackson T. Wright, Jan Basile, Srinivasan Beddhu, Udayan Bhatt, Tara I. Chang, Glenn M. Chertow, Michel Chonchol, Barry I. Freedman, William Haley, Joachim H. Ix, Lois A. Katz, Anthony A. Killeen, Vasilios Papademetriou, Ana C. Ricardo, Karen Servilla, Barry Wall, Dawn Wolfgram, Jerry Yee
JASN Sep 2017, 28 (9) 2812-2823; DOI: 10.1681/ASN.2017020148

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Effects of Intensive BP Control in CKD
Alfred K. Cheung, Mahboob Rahman, David M. Reboussin, Timothy E. Craven, Tom Greene, Paul L. Kimmel, William C. Cushman, Amret T. Hawfield, Karen C. Johnson, Cora E. Lewis, Suzanne Oparil, Michael V. Rocco, Kaycee M. Sink, Paul K. Whelton, Jackson T. Wright, Jan Basile, Srinivasan Beddhu, Udayan Bhatt, Tara I. Chang, Glenn M. Chertow, Michel Chonchol, Barry I. Freedman, William Haley, Joachim H. Ix, Lois A. Katz, Anthony A. Killeen, Vasilios Papademetriou, Ana C. Ricardo, Karen Servilla, Barry Wall, Dawn Wolfgram, Jerry Yee
JASN Sep 2017, 28 (9) 2812-2823; DOI: 10.1681/ASN.2017020148
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Keywords

  • blood pressure
  • chronic kidney disease
  • cardiovascular disease
  • glomerular filtration rate
  • hypertension
  • mortality

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