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Abstract: FR-PO367

Influence of Pre-Diabetes Status on the Effects of Intensive Systolic Blood Pressure (SBP) Lowering in the Systolic Blood Pressure Intervention Trial (SPRINT)

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Rathi, Naveen, 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
  • Greene, Tom, University of Utah, Salt Lake City, Utah, United States
  • Beddhu, Srinivasan, University of Utah, Salt Lake City, Utah, United States
Background

Intensive lowering of SBP increased the risk of incident CKD in people with type 2 diabetes mellitus. Hence, we examined the hypothesis that pre-diabetes increases the risk of incident CKD with intensive SBP lowering in persons without diabetes.

Methods

SPRINT tested the effects of intensive (<120 mm Hg) versus standard (<140 mm Hg) SBP goals on CVD outcomes. Diabetes was an exclusion criteria. Based on fasting blood glucose (FBG), we defined normoglycemic group as FBG < 100 mg/dl and pre-diabetes group as FBG ≥ 100 mg/dl in SPRINT participants without CKD at baseline. We defined incident CKD as ≥ 30% decline in eGFR to < 60 ml/min/1.73 m2 with a second confirmatory value. We examined in Cox regression models whether the risk for incident CKD with intensive SBP lowering differed by pre-diabetes status.

Results

Of the 6678 non-CKD SPRINT participants, 2829 (42.3%) had prediabetes. The baseline characteristics are summarized in the Table. Over 21155 total years of follow-up, there were 164 incident CKD events. The incidence of CKD was higher in the intensive arm compared to standard SBP arm within normoglycemia and pre-diabetes group (Fig 1), with similar hazard ratios (interaction p = 0.47).

Conclusion

Intensive SBP lowering increased the risk of incident CKD in persons with normoglycemia and prediabetes. There was no evidence that the presence of pre-diabetes modified the risk of incident CKD with intensive SBP lowering.

 FBG<100
N=3849
FBG≥100
N=2829
FBG(mg/dl)91±6111±13
Age(yr)#67±966±9
Female(%)#3828
Intensive SBP arm (%)5050
CVD(%)1819
SBP(mm Hg)#140±16139±15
DBP(mm Hg)80±1279±12
BMI(kg/m2)#29±633±6
eGFR(ml/min/1.73m2)81±1681±15
Urine albumin creatinine ratio (mg/g)9(5,17)9(5,17)

Relative risk differences of incident CKD by intervention arms and prediabetes status

Funding

  • NIDDK Support