SPRINT Trial: Greater Mean Blood Pressure Reductions Linked To Increased Risk of Kidney Function Decline

MedicalResearch.com Interview with:
Rita Magriço MD

Hospital Garcia de Orta
Almada, Portugal 
 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The SPRINT trial showed that in non-diabetic patients with high cardiovascular risk, intensive systolic blood pressure treatment (<120 mmHg) was associated with lower rates of major cardiovascular events and mortality. However, intensive treatment was unexpectedly associated with increased kidney function decline.

We thought that lowering blood pressure could compromise kidney perfusion, evaluated by mean arterial pressure (MAP). If so, the magnitude of MAP reduction was expected to be associated with kidney function decline. We hypothesized that a greater difference between the baseline MAP and the lowest achieved MAP may be associated with a higher risk of kidney function decline.

Our analysis supports this hypothesis. We discovered that MAP reduction >20 mmHg in patients with a target systolic BP <120 mmHg was associated with higher incidence of kidney function decline. The benefit-risk balance of intensive treatment seemed to be less favourable with greater MAP reduction. Prospective studies evaluating the effect of MAP reduction in addition to hypertension treatment target on kidney function decline and cardiovascular events are warranted.

MedicalResearch.com: What should clinicians and patients take away from your report?

Response: The SPRINT trial showed that in non-diabetic patients with high cardiovascular risk, intensive systolic blood pressure treatment (<120 mmHg) was associated with lower rates of major cardiovascular events and mortality.

The fact that in our analysis the benefit-risk relationship became less favourable with greater mean blood pressure reductions may be important for patients and physicians as they aim for the lowest cardiovascular risk with the lowest probability of side effects.

Patients undergoing anti-hypertensive treatment should be closely followed by their physicians to achieve the desired target safely.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Prospective studies evaluating the effect of MAP reduction in addition to hypertension treatment target on kidney function decline and cardiovascular events are warranted. If this association is confirmed by prospective studies, future recommendations for hypertension treatment in this population should consider personalized targets rather than a fixed cut-off for every patient.

In addition, the possibility that we can achieve the best of both worlds (minimal cardiovascular risk with no deterioration of renal function) is not excluded. Further research is necessary to find ways to achieve intensive lowering of blood pressure avoiding kidney function decline.

MedicalResearch.com: Is there anything else you would like to add?

Response: This investigation resulted from teamwork of five investigators: Rita Magriço, Miguel Bigotte Vieira, Catarina Viegas Dias, Lia Leitão, and João Sérgio Neves.

The authors acknowledge the patients that participated in the SPRINT trial and the organizers of “The SPRINT Data Analysis Challenge” of The New England Journal of Medicine. No funding was received for the completion of this study. 

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

ASN abstract and upcoming CJASN publication:

SPRINT trial:  intensive hypertension treatment and chronic kidney disease incidence”
Clinical Trials in CKD Tubulointerstitium
November 02, 2017 | Location: Room 392
Abstract Time: 04:42 PM – 04:54 PM

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

 

 

 

 

 

 

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