Effects of Intensive Systolic Blood Pressure Control on Kidney Outcomes in Patients With and Without CKD: A Post Hoc Analysis of SPRINT and ACCORD-BP Trials.

Background: The effects of intensive blood pressure (BP) control on adverse kidney outcomes remain undetermined.

Methods: This post hoc analysis included the Systolic Blood Pressure Intervention Trial (SPRINT) participants and the Action to Control Cardiovascular Risk in Diabetes Blood Pressure (ACCORD-BP) participants receiving standard glucose-lowering treatment and satisfying SPRINT eligibility criteria. The risks of kidney events between intensive (systolic BP < 120 mmHg) and standard (systolic BP < 140 mmHg) controls in participants with or without baseline chronic kidney disease (CKD) were compared using Cox proportional hazards models.

Results: A total of 10,946 participants (2724 with CKD and 8222 without CKD) were included. During the intervention and post-intervention periods, the risk of renal failure was either reduced by intensive BP control in participants with CKD (HR = 0.46; 95% CI = 0.22-0.97) or was not significantly different between intensive and standard BP control in participants without CKD (HR = 0.88, 95% CI = 0.52-1.49; p_interaction = 0.128). The risk of ≥ 30% reduction in estimated glomerular filtration rate (eGFR) was increased and the risk of albuminuria was decreased by intensive BP control in participants with or without CKD. Intensive BP control increased the risk of CKD progression to moderate- or high-risk category, but not to very-high risk category according to the Kidney Disease Improving Global Outcomes (KDIGO) risk categories.

Conclusions: The intensive BP control might increase the risk of mild CKD progression but not of more advanced CKD progression or renal failure compared with the standard BP control.