Abstract: FR-OR117

SPRINT Trial: Intensive Hypertension Treatment and CKD Incidence

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 301 CKD: Risk Factors for Incidence and Progression

Authors

  • Magriço, Rita, Hospital Garcia de Orta, Almada, Portugal
  • Bigotte Vieira, Miguel, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
  • Viegas dias, Catarina, Agrupamento de Centros de Saúde Lisboa Ocidental e Oeiras, Lisboa, Portugal
  • Leitão, Lia, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
  • Neves, João Sérgio, Hospital de São João, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
Background

The Systolic Blood Pressure Intervention Trial (SPRINT) 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 associated with increased CKD incidence. We evaluated the association between mean arterial pressure (MAP) reduction and CKD incidence in the intensive-treatment group.

Methods

We performed a secondary analysis of the SPRINT trial. We categorized patients in the intensive-treatment group according to MAP reduction: <20 mmHg; 20 to <40 mmHg; ≥40 mmHg. We defined the primary outcome as ≥30% reduction in eGFR to <60 ml/min/1.73m2, and the secondary outcome as cardiovascular events or death. We also performed a propensity score analysis, matching patients in each MAP reduction category from the intensive-treatment group with patients from the standard-treatment group, in order to calculate the number needed to treat (NNT) regarding cardiovascular events or mortality and the number needed to harm (NNH) regarding CKD incidence.

Results

1138 (34.4%) patients presented MAP reduction <20 mmHg, 1857 (56.3%) presented 20 to <40 mmHg and 309 (9.4%) ≥40 mmHg. Adjusted hazard ratios for CKD incidence were 2.14 (95% CI, 1.25-3.66) for MAP reduction between 20 and 40 mmHg and 6.35 (95% CI, 2.82-14.29) for MAP reduction ≥40 mmHg. In the propensity score analysis, MAP reduction <20 mmHg presented a NNT of 43.5 and a NNH of 65.4; MAP reduction between 20 and <40 mmHg presented a NNT of 41.7 and a NNH of 35.1 and MAP reduction ≥40 mmHg presented a NNT of 95.2 and a NNH of 15.9.

Conclusion

Higher categories of MAP reduction were associated with increased risk of CKD incidence. The benefit-risk balance of intensive treatment was less favourable as MAP reduction increased.