Abstract: TH-OR051

The Use of Four or More Drugs for Intensive Control of Blood Pressure Is Associated with Detrimental Renal Effects in the SPRINT

Session Information

Category: Hypertension

  • 1102 Hypertension: Basic and Experimental - Renal Causes and Consequences

Authors

  • Dasgupta, Indranil, Heartlands Hospital, Birmingham, United Kingdom
  • Mccallum, Linsay, Univeristy of Glasgow , Glasgow, United Kingdom
  • Jardine, Alan G., University of Glasgow, Glasgow, United Kingdom
  • Padmanabhan, Sandosh, University of Glasgow, Glasgow, United Kingdom
Background

In the SPRINT trial, A Randomized Trial of Intensive versus Standard Blood-Pressure Control, achievement of target SBP in the intensive arm required a higher number of drugs. Intensive treatment was associated with lower CV events and death but an increased incidence of adverse events. In this analysis we assessed the relationship between number of antihypertensive drugs classes used to achieve blood pressure target and renal adverse events.

Methods

Number of drug classes prescribed at randomisation and at 1,2,3,6,9,12 months were used to identify distinct trajectory groups in the standard and intensive arm using Latent Class Mixed Modelling, in 8,449 participants. Cox-PH models, adjusted for age, sex, SBP (AUC 0-12 months), prevalent CVD, prevalent CKD and number of drug classes at randomisation, were used to assess the association between drug class trajectories and renal adverse events.

Results

The 6 groups based on the trajectories of drug classes prescribed over the first year are shown in the panel A with corresponding SBP by drug class groups in panel B. Cox-PH model (reference category: Int-4, SBP <125 on 2.5 drug classes) showed that, in those without CKD at baseline, in Int-5 (125 on 4 drug classes) there was a higher risk of 30% reduction in eGFR (HR 4.25 [2.57-7.02]; p <0.0005) whilst those in Std-1 (SBP 133 on 1.5 drugs) had a lower risk (HR 0.17[0.10-0.29]; p <0.0005) (panel C. Those in Int-5 had a higher risk of hyperkalaemia (HR 1.64 [1.03-2.61]; p 0.036) with trend towards higher risk of AKI (HR 1.42 [0.95-2.12]; p 0.09).

Conclusion

Within the intensive arm of the SPRINT, treatment with ≥4 antihypertensive drug classes was associated with adverse renal events, independent of BP achieved in the first year.

Trajectories of number of antihypertensive drug classes used and GFR decline