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Abstract: FR-PO368

Associations of Early Decline in eGFR with Cardiovascular Disease (CVD) Events in the Systolic Blood Pressure Intervention Trial (SPRINT)

Session Information

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 armINT 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)
Female3334333634353240
AA (%)3433313033333028
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(%)2422243329252532
CVD (%)1919211921222119
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