TY - JOUR
T1 - Kidney Disease, Hypertension Treatment, and Cerebral Perfusion and Structure
AU - SPRINT Research Group
AU - Kurella Tamura, Manjula
AU - Gaussoin, Sarah
AU - Pajewski, Nicholas M.
AU - Zaharchuk, Greg
AU - Freedman, Barry I.
AU - Rapp, Stephen R.
AU - Auchus, Alexander P.
AU - Haley, William E.
AU - Oparil, Suzanne
AU - Kendrick, Jessica
AU - Roumie, Christianne L.
AU - Beddhu, Srinivasan
AU - Cheung, Alfred K.
AU - Williamson, Jeff D.
AU - Detre, John A.
AU - Dolui, Sudipto
AU - Bryan, R. Nick
AU - Nasrallah, Ilya M.
AU - Whelton, Paul
AU - Johnson, Karen C.
AU - Snyder, Joni
AU - Bild, Diane
AU - Bonds, Denise
AU - Cook, Nakela
AU - Cutler, Jeffrey
AU - Fine, Lawrence
AU - Kaufmann, Peter
AU - Kimmel, Paul
AU - Launer, Lenore
AU - Moy, Claudia
AU - Riley, William
AU - Ryan, Laurie
AU - Tolunay, Eser
AU - Yang, Song
AU - Reboussin, David
AU - Williamson, Jeff
AU - Ambrosius, Walter T.
AU - Applegate, William
AU - Evans, Greg
AU - Foy, Capri
AU - Kitzman, Dalane
AU - Lyles, Mary
AU - Pajewski, Nick
AU - Rapp, Steve
AU - Rushing, Scott
AU - Shah, Neel
AU - Sink, Kaycee M.
AU - Vitolins, Mara
AU - Wagenknecht, Lynne
AU - Bansal, Shweta
N1 - Publisher Copyright:
© 2021
PY - 2022/5
Y1 - 2022/5
N2 - Rationale & Objective: The safety of intensive blood pressure (BP) targets is controversial for persons with chronic kidney disease (CKD). We studied the effects of hypertension treatment on cerebral perfusion and structure in individuals with and without CKD. Study Design: Neuroimaging substudy of a randomized trial. Setting & Participants: A subset of participants in the Systolic Blood Pressure Intervention Trial (SPRINT) who underwent brain magnetic resonance imaging studies. Presence of baseline CKD was assessed by estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (UACR). Intervention: Participants were randomly assigned to intensive (systolic BP <120 mm Hg) versus standard (systolic BP <140 mm Hg) BP lowering. Outcomes: The magnetic resonance imaging outcome measures were the 4-year change in global cerebral blood flow (CBF), white matter lesion (WML) volume, and total brain volume (TBV). Results: A total of 716 randomized participants with a mean age of 68 years were enrolled; follow-up imaging occurred after a median 3.9 years. Among participants with eGFR <60 mL/min/1.73 m2 (n = 234), the effects of intensive versus standard BP treatment on change in global CBF, WMLs, and TBV were 3.38 (95% CI, 0.32 to 6.44) mL/100 g/min, −0.06 (95% CI, −0.16 to 0.04) cm3 (inverse hyperbolic sine-transformed), and −3.8 (95% CI, −8.3 to 0.7) cm3, respectively. Among participants with UACR >30 mg/g (n = 151), the effects of intensive versus standard BP treatment on change in global CBF, WMLs, and TBV were 1.91 (95% CI, −3.01 to 6.82) mL/100 g/min, 0.003 (95% CI, −0.13 to 0.13) cm3 (inverse hyperbolic sine-transformed), and −7.0 (95% CI, −13.3 to −0.3) cm3, respectively. The overall treatment effects on CBF and TBV were not modified by baseline eGFR or UACR; however, the effect on WMLs was attenuated in participants with albuminuria (P = 0.04 for interaction). Limitations: Measurement variability due to multisite design. Conclusions: Among adults with hypertension who have primarily early kidney disease, intensive versus standard BP treatment did not appear to have a detrimental effect on brain perfusion or structure. The findings support the safety of intensive BP treatment targets on brain health in persons with early kidney disease. Funding: SPRINT was funded by the National Institutes of Health (including the National Heart, Lung, and Blood Institute; the National Institute of Diabetes and Digestive and Kidney Diseases; the National Institute on Aging; and the National Institute of Neurological Disorders and Stroke), and this substudy was funded by the National Institutes of Diabetes and Digestive and Kidney Diseases. Trial Registration: SPRINT was registered at ClinicalTrials.gov with study number NCT01206062.
AB - Rationale & Objective: The safety of intensive blood pressure (BP) targets is controversial for persons with chronic kidney disease (CKD). We studied the effects of hypertension treatment on cerebral perfusion and structure in individuals with and without CKD. Study Design: Neuroimaging substudy of a randomized trial. Setting & Participants: A subset of participants in the Systolic Blood Pressure Intervention Trial (SPRINT) who underwent brain magnetic resonance imaging studies. Presence of baseline CKD was assessed by estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (UACR). Intervention: Participants were randomly assigned to intensive (systolic BP <120 mm Hg) versus standard (systolic BP <140 mm Hg) BP lowering. Outcomes: The magnetic resonance imaging outcome measures were the 4-year change in global cerebral blood flow (CBF), white matter lesion (WML) volume, and total brain volume (TBV). Results: A total of 716 randomized participants with a mean age of 68 years were enrolled; follow-up imaging occurred after a median 3.9 years. Among participants with eGFR <60 mL/min/1.73 m2 (n = 234), the effects of intensive versus standard BP treatment on change in global CBF, WMLs, and TBV were 3.38 (95% CI, 0.32 to 6.44) mL/100 g/min, −0.06 (95% CI, −0.16 to 0.04) cm3 (inverse hyperbolic sine-transformed), and −3.8 (95% CI, −8.3 to 0.7) cm3, respectively. Among participants with UACR >30 mg/g (n = 151), the effects of intensive versus standard BP treatment on change in global CBF, WMLs, and TBV were 1.91 (95% CI, −3.01 to 6.82) mL/100 g/min, 0.003 (95% CI, −0.13 to 0.13) cm3 (inverse hyperbolic sine-transformed), and −7.0 (95% CI, −13.3 to −0.3) cm3, respectively. The overall treatment effects on CBF and TBV were not modified by baseline eGFR or UACR; however, the effect on WMLs was attenuated in participants with albuminuria (P = 0.04 for interaction). Limitations: Measurement variability due to multisite design. Conclusions: Among adults with hypertension who have primarily early kidney disease, intensive versus standard BP treatment did not appear to have a detrimental effect on brain perfusion or structure. The findings support the safety of intensive BP treatment targets on brain health in persons with early kidney disease. Funding: SPRINT was funded by the National Institutes of Health (including the National Heart, Lung, and Blood Institute; the National Institute of Diabetes and Digestive and Kidney Diseases; the National Institute on Aging; and the National Institute of Neurological Disorders and Stroke), and this substudy was funded by the National Institutes of Diabetes and Digestive and Kidney Diseases. Trial Registration: SPRINT was registered at ClinicalTrials.gov with study number NCT01206062.
KW - Hypertension
KW - albuminuria
KW - blood pressure (BP)
KW - cerebral perfusion
KW - chronic kidney disease (CKD)
KW - intensive BP control
KW - magnetic resonance imaging (MRI)
KW - neuroimaging
KW - white matter injury
KW - white matter lesions
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U2 - 10.1053/j.ajkd.2021.07.024
DO - 10.1053/j.ajkd.2021.07.024
M3 - Article
C2 - 34543687
AN - SCOPUS:85121243697
SN - 0272-6386
VL - 79
SP - 677-687.e1
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 5
ER -