Abstract: FR-PO368
Associations of Early Decline in eGFR with Cardiovascular Disease (CVD) Events in the Systolic Blood Pressure Intervention Trial (SPRINT)
Session Information
- Hypertension and CVD: Clinical, Outcomes, Trials
October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1402 Hypertension and CVD: Clinical, Outcomes, and Trials
Authors
- Beddhu, Srinivasan, University of Utah, Salt Lake City, Utah, United States
- Kimmel, Paul L., National Institute of Diabetes and Digestive Kidney Diseases (NIDDK), Bethesda, Maryland, United States
- Chertow, Glenn Matthew, Stanford University School of Medicine, Palo Alto, California, United States
- Cheung, Alfred K., University of Utah, Salt Lake City, Utah, United States
- Wei, Guo, University of Utah, Salt Lake City, Utah, United States
- Boucher, Robert E., University of Utah, Salt Lake City, Utah, United States
- Chonchol, Michel, University of Colorado, Aurora, Colorado, United States
- Freedman, Barry I., Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
- Ix, Joachim H., UCSD, San Diego, California, United States
- Rocco, Michael V., Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
- Whelton, Paul K., Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
- Greene, Tom, University of Utah, Salt Lake City, Utah, United States
Background
SPRINT examined the cardiovascular effects of intensive (INT) vs. standard (STD) SBP goals (<120 vs. <140 mm Hg). INT SBP lowering resulted in early ↓ in eGFR but the clinical implications are unclear.
Methods
In a post-hoc analysis, based on % change in eGFR from baseline to 6 months, we defined four ΔeGFR groups (Table). Using -5 to +5% group as the reference, we related ΔeGFR groups to CVD events that occurred after 6 months in Cox regression models.
Results
15% in the STD vs. 26% in the INT SBP arms (p<0.001) had >10% ↓ in eGFR. Key baseline characteristics are summarized in the Table. Unadjusted Kaplan-Meier plots suggested higher incidence of CVD events in the group with >10% ↓ in eGFR within the STD SBP arm, which attenuated in an adjusted Cox regression model (Fig 1). There was no evidence that ΔeGFR groups associated with CVD events in the INT arm (Fig 2).
Conclusion
INT SBP lowering resulted in a higher proportion of persons with >10% ↓ in eGFR but there is no clear evidence that greater ↓ in eGFR was associated with worse CVD outcome in either arm during the trial. Further investigation of the implications of early eGFR ↓ on CVD is warranted.
Baseline characteristics by ΔeGFR groups in STD and INT arms
| STD arm | INT arm | ||||||||
| ≤ -10% N=642 | -10% to ≤-5% N=439 | -5% to ≤5% N=1,300 | > 5% N=1,909 | ≤ -10% N=1,107 | -10% to ≤-5% N=560 | -5% to ≤5% N=1,222 | > 5% N=1,432 | ||
| △ eGFR (%) | -18 (8) | -7 (1) | 0.1 (3) | 17 (12) | -20 (9) | -7 (1) | -0.1 (3) | 16 (11) | |
| Age (yr) | 68 (10) | 67 (10) | 68 (9) | 68 (9) | 68 (10) | 68 (9) | 68 (10) | 68 (9) | |
| Female | 33 | 34 | 33 | 36 | 34 | 35 | 32 | 40 | |
| AA (%) | 34 | 33 | 31 | 30 | 33 | 33 | 30 | 28 | |
| SBP (mmHg) | 145 (16) | 142(15) | 140 (15) | 137 (15) | 143 (16) | 140 (15) | 139 (16) | 137 (15) | |
| DBP (mmHg) | 80 (13) | 79 (12) | 78 (12) | 77 (12) | 79 (13) | 79 (12) | 78 (12) | 77 (11) | |
| CKD(%) | 24 | 22 | 24 | 33 | 29 | 25 | 25 | 32 | |
| CVD (%) | 19 | 19 | 21 | 19 | 21 | 22 | 21 | 19 | |
| eGFR (ml/min/1.73m2) | 77 (24) | 76 (21) | 73 (19) | 68 (19) | 73 (23) | 74 (21) | 73 (20) | 68 (19) | |
| Urine ACR (mg/g) | 11 (6-33) | 10 (6-23) | 9 (6-21) | 9 (5-19) | 12 (7-32) | 10 (6-20) | 9 (6-19) | 8 (5-17) | |
ΔeGFR groups and CVD events in STD arm
ΔeGFR groups and CVD events in INT arm
Funding
- NIDDK Support