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
- 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
- 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±6 | 111±13 |
Age(yr)# | 67±9 | 66±9 |
Female(%)# | 38 | 28 |
Intensive SBP arm (%) | 50 | 50 |
CVD(%) | 18 | 19 |
SBP(mm Hg)# | 140±16 | 139±15 |
DBP(mm Hg) | 80±12 | 79±12 |
BMI(kg/m2)# | 29±6 | 33±6 |
eGFR(ml/min/1.73m2) | 81±16 | 81±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