ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: PO2093

The Influence of Baseline Diastolic Blood Pressure on the Effects of Blood Pressure Lowering on Death and ESKD Outcome

Session Information

Category: Hypertension and CVD

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

Authors

  • Ilkun, Olesya, Division of Nephrology & Hypertension, University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Wei, Guo, Division of Nephrology & Hypertension, University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Boucher, Robert E., Division of Nephrology & Hypertension, University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Beddhu, Srinivasan, Division of Nephrology & Hypertension, University of Utah School of Medicine, Salt Lake City, Utah, United States
Background

Intensive systolic blood pressure (SBP) lowering decreased the risk of death in SPRINT. However, there are concerns in those with low baseline diastolic blood pressure (DBP) that intensive BP lowering might adversely affect kidney perfusion and increase the risk for death/ ESKD.

Methods

The African-American Study of Kidney Disease and Hypertension (AASK) trial examined the effects of two different BP goals (mean arterial pressure (MAP) < 92 vs ≥ 102-109) in African American men and women (N =1094) with kidney disease but no diabetes. We investigated whether the effectts of BP intervention on the risk of death/ESKD was modified by baseline DBP.

Results

Mean baseline age was 55 ± 11 yrs and DBP 95 ± 14 mmHg. There were 264 death/ESKD events over 4714 years of follow-up., Compared to usual BP control, low BP goal resulted in lower levels of follow-up SBP, MAP and DBP across baseline DBP tertiles (Fig 1). Despite the lower follow-up MAP and DBP values, there was no evidence that low BP goal increased the risk of death/ESKD in those with low baseline DBP (Fig 2). Interaction of baseline DBP and BP intervention for death/ESKD was not significant (p =0.22).

Conclusion

The effect of BP lowering on the risk of death/ESKD was not modified by low baseline DBP. Hence, low baseline DBP by itself should not be an impediment for intensive BP lowering in CKD.

Figure 1. Mean follow-up SBP, DBP and MAP by BP arm in baseline DBP tertiles

Figure 2. Spline regression model of the effects of BP intervention on death/ESKD outcome across the range of baseline DBP

Funding

  • NIDDK Support