Effect of Intensive Versus Usual Blood Pressure Control on Kidney Function among Individuals with Prior Lacunar Stroke: A Post Hoc Analysis of the Secondary Prevention of Small Subcortical Strokes (SPS3) Randomized Trial

Carmen A. Peralta, Leslie A. McClure, Rebecca Scherzer, Michelle C. Odden, Carole L. White, Michael Shlipak, Oscar Benavente, Pablo Pergola

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34 Scopus citations

Abstract

Background-The effect of intensive blood pressure (BP) lowering on kidney function among individuals with established cerebrovascular disease and preserved estimated glomerular filtration rate (eGFR) is not established. Methods and Results-Among 2610 participants randomized to a lower (30%) using linear mixed models and logistic regression, respectively. We assessed associations of both treatment and kidney function decline with stroke, major vascular events, and the composite of stroke, death, major vascular events, or myocardial infarction using multivariable Cox regression, separately and jointly including a test for interaction. Analyses were conducted by treatment arm. Mean age was 63±11 years; 949 participants (36%) were diabetic; and mean eGFR was 80±19 mL·min-1·1.73 m-2. At 9 months, achieved systolic BP was 137±15 versus 127±14 mm Hg in the higher versus lower BP group, and differences were maintained throughout follow-up (mean, 3.2 years). Compared with the higher target, the lower BP target had a-0.50-mL·min-1·1.73 m-2 per year (95% confidence interval [CI],-0.79 to-0.21) faster eGFR decline. Differences were most pronounced during the first year (-2.1 mL·min-1·1.73 m-2; 95% CI,-0.97 to-3.2), whereas rates of eGFR decline did not differ after year 1 (-0.095; 95% CI,-0.47 to 0.23). A total of 313 patients (24%) in the lower BP group had rapid kidney function decline compared with 247 (19%) in the higher BP group (odds ratio, 1.4; 95% CI, 1.1-1.6). Differences in rapid decline by treatment arm were apparent in the first year (odds ratio, 1.4; 95% CI, 1.1-1.8) but were not significant after year 1 (odds ratio, 1.0; 95% CI, 0.73-1.4). Rapid decline was associated with higher risk for stroke, major vascular events, and composite after full adjustment among individuals randomized to the higher BP target (stroke hazard ratio, 1.93; 95% CI, 1.15-3.21) but not the lower BP arm (stroke hazard ratio, 0.93; 95% CI, 0.50-1.75; all P for interaction

Original languageEnglish (US)
Pages (from-to)584-591
Number of pages8
JournalCirculation
Volume133
Issue number6
DOIs
Publication statusPublished - Feb 9 2016
Externally publishedYes

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Keywords

  • cerebrovascular disorders
  • hypertension
  • kidney
  • stroke

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

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