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Effect of Blood Pressure Control on Long‐Term Risk of End‐Stage Renal Disease and Death Among Subgroups of Patients With Chronic Kidney Disease
BACKGROUND: Our objective was to explore the effect of intensive blood pressure (BP) control on kidney and death outcomes among subgroups of patients with chronic kidney disease divided by baseline proteinuria, glomerular filtration rate, age, and body mass index. METHODS AND RESULTS: We included 84...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6759905/ https://www.ncbi.nlm.nih.gov/pubmed/31411082 http://dx.doi.org/10.1161/JAHA.119.012749 |
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author | Ku, Elaine Sarnak, Mark J. Toto, Robert McCulloch, Charles E. Lin, Feng Smogorzewski, Miroslaw Hsu, Chi‐yuan |
author_facet | Ku, Elaine Sarnak, Mark J. Toto, Robert McCulloch, Charles E. Lin, Feng Smogorzewski, Miroslaw Hsu, Chi‐yuan |
author_sort | Ku, Elaine |
collection | PubMed |
description | BACKGROUND: Our objective was to explore the effect of intensive blood pressure (BP) control on kidney and death outcomes among subgroups of patients with chronic kidney disease divided by baseline proteinuria, glomerular filtration rate, age, and body mass index. METHODS AND RESULTS: We included 840 MDRD (Modification of Diet in Renal Disease) trial and 1067 AASK (African American Study of Kidney Disease and Hypertension) participants. We used Cox models to examine whether the association between intensive BP control and risk of end‐stage renal disease (ESRD) or death is modified by baseline proteinuria (≥0.44 versus <0.44 g/g), glomerular filtration rate (≥30 versus <30 mL/min per 1.73 m(2)), age (≥40 versus <40 years), or body mass index (≥30 versus <30 kg/m(2)). The median follow‐up was 14.9 years. Strict (versus usual) BP control was protective against ESRD (hazard ratio [HR](ESRD), 0.77; 95% CI, 0.64–0.92) among those with proteinuria ≥0.44 g/g but not proteinuria <0.44 g/g. Strict (versus usual) BP control was protective against death (HR (death), 0.73; 95% CI, 0.59–0.92) among those with glomerular filtration rate <30 mL/min per 1.73 m(2) but not glomerular filtration rate ≥30 mL/min per 1.73 m(2) (HR (death), 0.98; 95% CI, 0.84–1.15). Strict (versus usual) BP control was protective against ESRD among those ≥40 years (HR(ESRD) (,) 0.82; 95% CI, 0.71–0.94) but not <40 years. Strict (versus usual) BP control was also protective against ESRD among those with body mass index ≥30 kg/m(2) (HR(ESRD) (,) 0.75; 95% CI, 0.61–0.92) but not body mass index <30 kg/m(2). CONCLUSIONS: The ESRD and all‐cause mortality benefits of intensive BP lowering may not be uniform across all subgroups of patients with chronic kidney disease. But intensive BP lowering was not associated with increased risk of ESRD or death among any subgroups that we examined. |
format | Online Article Text |
id | pubmed-6759905 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-67599052019-09-30 Effect of Blood Pressure Control on Long‐Term Risk of End‐Stage Renal Disease and Death Among Subgroups of Patients With Chronic Kidney Disease Ku, Elaine Sarnak, Mark J. Toto, Robert McCulloch, Charles E. Lin, Feng Smogorzewski, Miroslaw Hsu, Chi‐yuan J Am Heart Assoc Original Research BACKGROUND: Our objective was to explore the effect of intensive blood pressure (BP) control on kidney and death outcomes among subgroups of patients with chronic kidney disease divided by baseline proteinuria, glomerular filtration rate, age, and body mass index. METHODS AND RESULTS: We included 840 MDRD (Modification of Diet in Renal Disease) trial and 1067 AASK (African American Study of Kidney Disease and Hypertension) participants. We used Cox models to examine whether the association between intensive BP control and risk of end‐stage renal disease (ESRD) or death is modified by baseline proteinuria (≥0.44 versus <0.44 g/g), glomerular filtration rate (≥30 versus <30 mL/min per 1.73 m(2)), age (≥40 versus <40 years), or body mass index (≥30 versus <30 kg/m(2)). The median follow‐up was 14.9 years. Strict (versus usual) BP control was protective against ESRD (hazard ratio [HR](ESRD), 0.77; 95% CI, 0.64–0.92) among those with proteinuria ≥0.44 g/g but not proteinuria <0.44 g/g. Strict (versus usual) BP control was protective against death (HR (death), 0.73; 95% CI, 0.59–0.92) among those with glomerular filtration rate <30 mL/min per 1.73 m(2) but not glomerular filtration rate ≥30 mL/min per 1.73 m(2) (HR (death), 0.98; 95% CI, 0.84–1.15). Strict (versus usual) BP control was protective against ESRD among those ≥40 years (HR(ESRD) (,) 0.82; 95% CI, 0.71–0.94) but not <40 years. Strict (versus usual) BP control was also protective against ESRD among those with body mass index ≥30 kg/m(2) (HR(ESRD) (,) 0.75; 95% CI, 0.61–0.92) but not body mass index <30 kg/m(2). CONCLUSIONS: The ESRD and all‐cause mortality benefits of intensive BP lowering may not be uniform across all subgroups of patients with chronic kidney disease. But intensive BP lowering was not associated with increased risk of ESRD or death among any subgroups that we examined. John Wiley and Sons Inc. 2019-08-14 /pmc/articles/PMC6759905/ /pubmed/31411082 http://dx.doi.org/10.1161/JAHA.119.012749 Text en © 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Original Research Ku, Elaine Sarnak, Mark J. Toto, Robert McCulloch, Charles E. Lin, Feng Smogorzewski, Miroslaw Hsu, Chi‐yuan Effect of Blood Pressure Control on Long‐Term Risk of End‐Stage Renal Disease and Death Among Subgroups of Patients With Chronic Kidney Disease |
title | Effect of Blood Pressure Control on Long‐Term Risk of End‐Stage Renal Disease and Death Among Subgroups of Patients With Chronic Kidney Disease |
title_full | Effect of Blood Pressure Control on Long‐Term Risk of End‐Stage Renal Disease and Death Among Subgroups of Patients With Chronic Kidney Disease |
title_fullStr | Effect of Blood Pressure Control on Long‐Term Risk of End‐Stage Renal Disease and Death Among Subgroups of Patients With Chronic Kidney Disease |
title_full_unstemmed | Effect of Blood Pressure Control on Long‐Term Risk of End‐Stage Renal Disease and Death Among Subgroups of Patients With Chronic Kidney Disease |
title_short | Effect of Blood Pressure Control on Long‐Term Risk of End‐Stage Renal Disease and Death Among Subgroups of Patients With Chronic Kidney Disease |
title_sort | effect of blood pressure control on long‐term risk of end‐stage renal disease and death among subgroups of patients with chronic kidney disease |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6759905/ https://www.ncbi.nlm.nih.gov/pubmed/31411082 http://dx.doi.org/10.1161/JAHA.119.012749 |
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