Abstract: TH-OR034

Influence of Baseline Diastolic Blood Pressure (DBP) Level on the Effects of Intensive Blood Pressure Lowering on Incident CKD in SPRINT

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 305 CKD: Clinical Trials and Tubulointerstitial Disorders

Authors

  • Beddhu, Srini, Univ Utah, SLC, Utah, United States
  • Chertow, Glenn Matthew, Stanford, Palo Alto, California, United States
  • Cheung, Alfred K., Univ Utah, SLC, Utah, United States
  • Rahman, Mahboob, CWRU, Cleveland, Ohio, United States
  • Greene, Tom, Univ Utah, SLC, Utah, United States
  • Wei, Guo, Univ Utah, SLC, Utah, United States
  • Haley, William E., Mayo Clinic, Jacksonville, Florida, United States
  • Cushman, William C., Memphis VA Medical Center, Memphis, Tennessee, United States
  • Whelton, Paul K., Tulane Univ, New Orleans, Louisiana, United States

Group or Team Name

  • For SPRINT Research Group
Background

Lowering systolic blood pressure (SBP) in persons with low DBP might affect kidney perfusion and thereby, ↑ risk for incident CKD.

Methods

SPRINT tested the effects of SBP goal < 120 vs. < 140 mm Hg on CV outcomes. We tested for effect modification by baseline DBP of the intervention on incident CKD (defined as a >30% decrease in eGFR to a value <60 ml/min/1.73 m2) in participants without CKD at baseline (N = 6677).

Results

Participants with lower baseline DBP were older, had ↑ prevalence of CV disease and ↓ eGFR (table). There was a U-shaped relation between baseline DBP and incident CKD (Fig Panel A). Within each baseline DBP quintile, participants randomized to the intensive arm had a higher hazard ratio of incident CKD (Fig Panel B). P-value for comparison of hazard ratios in the lowest quintile to the upper 4 quintiles was non-significant (p = 0.79). P-value for the linear treatment by baseline DBP interaction was also non-significant (p = 0.94).

Conclusion

Lower baseline DBP was associated with ↑ risk of incident CKD, but there was no evidence that the effects of intensive SBP lowering on incident CKD differed by baseline DBP.

Baseline characteristics by baseline quintiles of DBP in non-CKD subgroup in SPRINT (N=6677)
Variable name1st quintile
<71
(N=1460)
2nd quintile
71-76
(N=1283)
3rd quintile
77-82
(N=1365)
4th quintile
83-89
(N=1356)
5th quintile
>89
(N=1251)
P value
DBP (mm Hg)64 ± 573 ± 280 ± 286 ± 296 ± 6 
Age (year)72.5 ± 8.567.9 ± 8.265.9 ± 8.363.6 ± 7.760.9 ± 7.6<0.001
Female (%)37.932.731.631.634.50.002
Black race (%)25.729.632.437.048.1<0.001
History of cardiovascular disease (%)26.618.915.315.215.0<0.001
Never smoked43.342.744.945.341.20.20
Antihypertensive agents (# / patient)2.0 ± 1.01.8 ± 1.01.7 ± 1.01.6 ± 1.01.5 ± 1.1<0.001
SBP (mm Hg)131 ± 14135 ± 13139 ± 13142 ± 13153 ± 15<0.001
BMI (kg/m2)28.5 ± 5.329.9 ± 5.830.2 ± 5.830.6 ± 5.731.0 ± 6.0<0.001
eGFR (ml/min/1.73 m2)79 ± 1580 ± 1581 ± 1682 ± 1683 ± 17<0.001
Urine ACR (mg/g)9.1(5.7,17.0)8.3(5.3,16.7)8.0(5.2,15.7)8.4(5.4,16.0)9.6(5.9,20.0)<0.001
 

Funding

  • NIDDK Support