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Abstract: SA-PO542

Effect of Intensive Blood Pressure Control on Kidney Outcomes: Long-Term EHR-Based Post-Trial Follow-Up of SPRINT

Session Information

Category: Hypertension and CVD

  • 1602 Hypertension and CVD: Clinical

Authors

  • Drawz, Paul E., University of Minnesota Twin Cities School of Medicine, Minneapolis, Minnesota, United States
  • Lenoir, Kristin M., Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
  • Rai, Nayanjot Kaur, University of Minnesota Twin Cities School of Medicine, Minneapolis, Minnesota, United States
  • Pajewski, Nicholas M., Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
Background

Intensive blood pressure (BP) lowering in SPRINT produced acute decreases in kidney function and increased the risk of AKI. We evaluated the effect of intensive BP lowering on long-term changes in kidney function using trial data supplemented with outpatient EHR creatinine values.

Methods

SPRINT data were linked with EHR data from 49 (of 102) SPRINT study sites. The primary outcome was the slope of decline in eGFR calculated using trial and outpatient EHR values. Secondary outcomes included a ≥30% decline in eGFR to <60ml/min/1.73m2 and a ≥50% decline in eGFR in participants with eGFR ≥60 and <60ml/min/1.73m2 at baseline, respectively.

Results

EHR creatinine values were available for a median of 8.7 years for 3041 participants. The long-term slope of decline in eGFR was -1.09 ml/min/1.73m2/year (95% CI -1.17 to -1.01) in the standard treatment group and -0.72 ml/min/1.73m2/year (95% CI -0.80 to -0.64) in the intensive treatment group (P <0.001). Among participants without CKD at baseline, intensive compared to standard treatment was associated with an increased risk of a ≥30% decline in eGFR during the intervention (hazard ratio (HR) 3.29, 95% CI 2.35, 4.60), but not during the post-intervention observation phase (HR 1.09, 95% CI 0.84, 1.42). There was no significant effect of intensive treatment on eGFR decline in those with CKD at baseline. Estimates of kidney outcomes during the intervention period were similar when using SPRINT and EHR creatinine values.

Conclusion

Intensive BP lowering was associated with a lesser slope of decline in eGFR compared with standard BP lowering during long-term follow-up in SPRINT. However, there was no consistent benefit of intensive BP lowering on secondary kidney outcomes.

Long-term slope of eGFR including both SPRINT and EHR creatinine values starting 6 months after randomization

Funding

  • Other NIH Support