Effect of Intensive Blood Pressure Control on Kidney Outcomes: Long-Term Electronic Health Record-Based Post-Trial Follow-Up of SPRINT

Paul E. Drawz, Division of Nephrology and Hypertension, University of Minnesota, Minneapolis, Minnesota.
Kristin M. Lenoir, Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
Nayanjot Kaur Rai, Division of Nephrology and Hypertension, University of Minnesota, Minneapolis, Minnesota.
Anjay Rastogi, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
Chi D. Chu, Department of Medicine, University of California, San Francisco, San Francisco, California.
Frederic F. Rahbari-Oskoui, Emory University School of Medicine, Atlanta, Georgia.
Paul K. Whelton, Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.
George Thomas, Department of Kidney Medicine, Cleveland Clinic, Cleveland, Ohio.
Andrew McWilliams, Department of Internal Medicine, Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, North Carolina.
Anil K. Agarwal, Department of Medicine, Veterans Affairs Central California Health Care System, Fresno, California.
Maritza Marie Suarez, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida.
Mirela Dobre, Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio.
James Powell, Division of General Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, North Carolina.
Michael V. Rocco, Section on Nephrology, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
James P. Lash, Division of Nephrology, University of Illinois at Chicago, Chicago, Illinois.
Suzanne Oparil, Division of Cardiovascular Disease, University of Alabama-Birmingham, Birmingham, Alabama.
Dominic S. Raj, Division of Kidney Diseases and Hypertension, George Washington University, Washington, DC.
Jamie P. Dwyer, Division of Nephrology and Hypertension, University of Utah Health, Salt Lake City, Utah.
Mahboob Rahman, Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio.
Sandeep Soman, Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, Michigan.
Raymond R. Townsend, Perelman School of Medicine University of Pennsylvania, Philadelphia, Pennsylvania.
Priscilla Pemu, Morehouse School of Medicine, Atlanta, Georgia.
Edward Horwitz, Division of Nephrology & Hypertension, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.
Joachim H. Ix, Division of Nephrology-Hypertension, University of California San Diego, Veterans Affairs San Diego Healthcare System, San Diego, California.
Delphine S. Tuot, Department of Medicine, University of California, San Francisco, San Francisco, California.
Areef Ishani, Division of Nephrology and Hypertension, University of Minnesota, Minneapolis, Minnesota.
Nicholas M. Pajewski, Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina.

Document Type

Journal Article

Publication Date

10-25-2023

Journal

Clinical journal of the American Society of Nephrology : CJASN

DOI

10.2215/CJN.0000000000000335

Abstract

BACKGROUND: Intensive BP lowering in the Systolic Blood Pressure Intervention Trial (SPRINT) produced acute decreases in kidney function and higher risk for AKI. We evaluated the effect of intensive BP lowering on long-term changes in kidney function using trial and outpatient electronic health record (EHR) creatinine values. METHODS: SPRINT data were linked with EHR data from 49 (of 102) study sites. The primary outcome was the total slope of decline in eGFR for the intervention phase and the post-trial slope of decline during the observation phase using trial and outpatient EHR values. Secondary outcomes included a ≥30% decline in eGFR to <60 ml/min per 1.73 m 2 and a ≥50% decline in eGFR or kidney failure among participants with baseline eGFR ≥60 and <60 ml/min per 1.73 m 2 , respectively. RESULTS: EHR creatinine values were available for a median of 8.3 years for 3041 participants. The total slope of decline in eGFR during the intervention phase was -0.67 ml/min per 1.73 m 2 per year (95% confidence interval [CI], -0.79 to -0.56) in the standard treatment group and -0.96 ml/min per 1.73 m 2 per year (95% CI, -1.08 to -0.85) in the intensive treatment group ( P < 0.001). The slopes were not significantly different during the observation phase: -1.02 ml/min per 1.73 m 2 per year (95% CI, -1.24 to -0.81) in the standard group and -0.85 ml/min per 1.73 m 2 per year (95% CI, -1.07 to -0.64) in the intensive group. Among participants without CKD at baseline, intensive treatment was associated with higher risk of a ≥30% decline in eGFR during the intervention (hazard ratio, 3.27; 95% CI, 2.43 to 4.40), but not during the postintervention observation phase. In those with CKD at baseline, intensive treatment was associated with a higher hazard of eGFR decline only during the intervention phase (hazard ratio, 1.95; 95% CI, 1.03 to 3.70). CONCLUSIONS: Intensive BP lowering was associated with a steeper total slope of decline in eGFR and higher risk for kidney events during the intervention phase of the trial, but not during the postintervention observation phase.

Department

Medicine

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