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Abstract: SA-OR053

Modification of Effect of Intensive Blood Pressure Lowering on Cardiovascular (CV) Outcomes by Baseline eGFR in the Secondary Prevention of Small Subcortical Strokes (SPS3) Trial

Session Information

Category: Hypertension and CVD

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

Authors

  • Agarwal, Adhish, University of Utah, Salt Lake City, Utah, United States
  • Li, Man, University of Utah, Salt Lake City, Utah, United States
  • Ma, Jianing, University of Utah, Salt Lake City, Utah, United States
  • Cheung, Alfred K., University of Utah, Salt Lake City, Utah, United States
Background

The SPRINT trial reported CV benefits of intensive (INT) systolic blood pressure (SBP) target of <120 mm Hg vs. <140 mm Hg in patients with and without CKD. However, SPRINT excluded patients with a history of stroke. The SPS3 trial examined the CV effects of INT SBP control in patients with previous stroke and found a non-significant reduction in all (recurrent) stroke (hazard ratio [HR] 0.81, 95% CI 0.64-1.03) and the CV composite outcome of myocardial infarction (MI) or vascular death (HR 0.84, 95% CI 0.68-1.04). We conducted a post hoc analysis of the SPS3 trial to examine whether baseline eGFR modified the effects of INT SBP control on CV events in patients with a history of stroke.

Methods

3,020 patients with recent MRI-defined symptomatic lacunar infarctions were randomized to a SBP target of <130 mm Hg vs. 130-149 mm Hg. Among 3,017 patients with valid baseline eGFR measurements, we evaluated the effects of INT SBP control on the risk of recurrent stroke and CV composite outcome (stroke, acute MI or death) during the 3.7 years of mean follow-up in two strata defined by baseline eGFR (<60 or ≥60 ml/min/1.73m2) using Cox proportional models. We also tested the interaction between treatment group and baseline eGFR.

Results

Non-significant rate reduction by INT SBP control was seen for all (recurrent) stroke and the composite outcome in both eGFR strata. In the eGFR <60 ml/min/1.73m2 subgroup (N=303, mean eGFR 51.22 ml/min/1.73m2), the HR was 0.84 (95% CI, 0.46-1.56) for all stroke, and 0.92 (95% CI, 0.58-1.44) for the CV composite outcome. In the eGFR ≥60 ml/min/1.73m2 subgroup (N=2714, mean eGFR 90.08 ml/min/1.73m2), the HR was 0.83 (95%, 0.64-1.07) for all stroke, and 0.90 (95%, 0.74-1.09) for the CV composite outcome. Baseline eGFR did not significantly modify the effect of INT SBP control on either all stroke (Pinteraction=0.74) or the CV composite outcome (Pinteraction=0.45).

Conclusion

Baseline eGFR did not modify the effects of INT SBP lowering on CV events among patients with previous stroke. Studies with adequate statistical power in patients with a wide range of kidney functions are needed to provide conclusive evidence of SBP targets in CKD.