TY - JOUR
T1 - BP control and long-term risk of ESRD and mortality
AU - Ku, Elaine
AU - Gassman, Jennifer
AU - Appel, Lawrence J.
AU - Smogorzewski, Miroslaw
AU - Sarnak, Mark J.
AU - Glidden, David V.
AU - Bakris, George
AU - Gutiérrez, Orlando M.
AU - Hebert, Lee A.
AU - Ix, Joachim H.
AU - Lea, Janice
AU - Lipkowitz, Michael S.
AU - Norris, Keith
AU - Ploth, David
AU - Pogue, Velvie A.
AU - Rostand, Stephen G.
AU - Siew, Edward D.
AU - Sika, Mohammed
AU - Tisher, C. Craig
AU - Toto, Robert
AU - Wright, Jackson T.
AU - Wyatt, Christina
AU - Hsu, Chi Yuan
N1 - Publisher Copyright:
© 2017 by the American Society of Nephrology.
PY - 2017/2
Y1 - 2017/2
N2 - We recently showed an association between strict BP control and lower mortality risk during two decades of follow-up of prior participants in the Modification of Diet in RenalDisease (MDRD) trial. Here, wedetermined the risk of ESRD and mortality during extended follow-up of the African American Study of Kidney Disease and Hypertension (AASK) trial. Welinked 1067 former AASK participants with CK Dpreviously randomized to strict or usual BP control (mean arterial pressure ≤92 mmHg or 102-107 mmHg, respectively) to the US Renal Data System and Social Security Death Index; 397 patients hadESRDand 475 deaths occurred during amedian followup of 14.4 years from 1995 to 2012. Compared with the usual BP arm, the strict BP arm had unadjusted and adjusted relative risks of ESRD of 0.92 (95% confidence interval [95%CI], 0.75 to 1.12) and 0.95 (95%CI, 0.78 to 1.16; P=0.64), respectively, and unadjusted and adjusted relative risks of death of 0.92 (95% CI, 0.77 to 1.10) and 0.81 (95% CI, 0.68 to0.98;P=0.03), respectively. Inmeta-analyses of individual-level data fromthe MDRD and the AASK trials, unadjusted relative risk of ESRD was 0.88 (95% CI, 0.78 to 1.00) and unadjusted relative risk of death was 0.87 (95%CI, 0.76 to 0.99) for strict versus usualBP arms.Our findings suggest that,during long-termfollowup, strict BP control does not delay the onset of ESRD but may reduce the relative risk of death in CKD.
AB - We recently showed an association between strict BP control and lower mortality risk during two decades of follow-up of prior participants in the Modification of Diet in RenalDisease (MDRD) trial. Here, wedetermined the risk of ESRD and mortality during extended follow-up of the African American Study of Kidney Disease and Hypertension (AASK) trial. Welinked 1067 former AASK participants with CK Dpreviously randomized to strict or usual BP control (mean arterial pressure ≤92 mmHg or 102-107 mmHg, respectively) to the US Renal Data System and Social Security Death Index; 397 patients hadESRDand 475 deaths occurred during amedian followup of 14.4 years from 1995 to 2012. Compared with the usual BP arm, the strict BP arm had unadjusted and adjusted relative risks of ESRD of 0.92 (95% confidence interval [95%CI], 0.75 to 1.12) and 0.95 (95%CI, 0.78 to 1.16; P=0.64), respectively, and unadjusted and adjusted relative risks of death of 0.92 (95% CI, 0.77 to 1.10) and 0.81 (95% CI, 0.68 to0.98;P=0.03), respectively. Inmeta-analyses of individual-level data fromthe MDRD and the AASK trials, unadjusted relative risk of ESRD was 0.88 (95% CI, 0.78 to 1.00) and unadjusted relative risk of death was 0.87 (95%CI, 0.76 to 0.99) for strict versus usualBP arms.Our findings suggest that,during long-termfollowup, strict BP control does not delay the onset of ESRD but may reduce the relative risk of death in CKD.
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U2 - 10.1681/ASN.2016030326
DO - 10.1681/ASN.2016030326
M3 - Article
C2 - 27516235
AN - SCOPUS:85019130462
SN - 1046-6673
VL - 28
SP - 671
EP - 677
JO - Journal of the American Society of Nephrology
JF - Journal of the American Society of Nephrology
IS - 2
ER -