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Abstract: SA-OR38

Renal Hyperfiltration and the Effect of Intensive vs. Standard Blood Pressure Lowering on Cardiovascular Outcomes

Session Information

Category: Hypertension and CVD

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

Authors

  • Odutayo, Ayodele, University of Toronto, Toronto, Ontario, Canada
  • Iskander, Samir M., University of Toronto, Toronto, Ontario, Canada
  • Roble, Fatimah, University of Toronto, Toronto, Ontario, Canada
  • Juni, Peter, University of Toronto, Toronto, Ontario, Canada
  • Razak, Fahad, University of Toronto, Toronto, Ontario, Canada
  • Verma, Amol, University of Toronto, Toronto, Ontario, Canada
Background

Using the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial and Systolic Blood Pressure Intervention Trial (SPRINT), we examined whether the effect of intensive versus standard blood pressure (BP) lowering on cardiovascular outcomes varies by the presence of renal hyperfiltration (RHF).

Methods

We pooled data on adults in ACCORD and SPRINT without chronic kidney disease (eGFR>60 and urine albumin-to-creatinine ratio <30 mg/g). RHF was defined as an eGFR above the 95th percentile for healthy adults in the National Health and Nutrition Examination Survey. Outcomes of interest were major adverse cardiovascular events (MACE, as defined in the ACCORD primary outcome): a composite of cardiovascular (CV) mortality, acute myocardial infarction (AMI) and stroke. Secondary outcomes were all-cause mortality, CV mortality and CV events. We used fixed effect cox regression.

Results

There were 1046 (13%) adults with RHF and 7192 adults with normal filtration. RHF modified the effect of intensive versus standard BP lowering on MACE (p-interaction=0.002) but not all-cause mortality (p-interaction=0.059). For adults with RHF, intensive BP lowering reduced incidence of MACE compared with standard BP lowering (HR: 0.22, 95%-CI: 0.10-0.49). The risk reduction was smaller in adults with normal filtration (HR: 0.84, 95%-CI: 0.67-1.06). Intensive BP lowering was also associated with a larger reduction in the incidence of CV mortality and stroke among adults with RHF (Figure, p-interaction≤0.035) but not AMI or heart failure (p-interaction≥0.41). Separate analyses of ACCORD and SPRINT were similar.

Conclusion

RHF modified the effect of intensive versus standard BP lowering on cardiovascular outcomes.

Intensive Versus Standard Blood Pressure Lowering and Cardiovascular Outcomes in Adults With and Without Renal Hyperfiltration (Pooled Analysis)