Abstract: SA-OR38
Renal Hyperfiltration and the Effect of Intensive vs. Standard Blood Pressure Lowering on Cardiovascular Outcomes
Session Information
- Hypertension and Vascular Disease: From the Lab to Trials
October 24, 2020 | Location: Simulive
Abstract Time: 05:00 PM - 07:00 PM
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)