Table 1.
Randomized trials of blood pressure target for CV outcomes in NDD-CKD
| Trial | BP Target* | Comparator* | Duration (y) | Sample (mean eGFR±SD) | CV Outcome Events |
|---|---|---|---|---|---|
| MDRD Study4 (1994) | MAP 92a | MAP 107 | 2.2 | 585 w/eGFR 25–55 (38.6±8.9); 255 w/eGFR 13–24 (18.5±3.4) | CV death: NS |
| REIN-25 (2005) | BP <130/80 | BP <140/90 | 1.6 | 338 w/non-DM CKD3-4 (34.1±18.1 vs. 35.9±18.6) | CV death: NS |
| AASK6 (2010) | MAP ≤92 | MAP 102–107 | 3.8 | 1,094 blacks w/HTN and CKD (46.0±12.9 vs. 45.3±13.2) | CV death or CV event rate: NS |
| ACCORD7 (2010) | SBP <120 | SBP <140 | 8.0 | 4,733 T2DM pts; sCr ≤1.5, of which 1,703 w/albuminuria (eGFR NR) | HR for all: 0.88 (95% CI, 0.73–1.06); NDD-CKD subgroup NR |
| SPRINT8 (2015) | SBP <120 | SBP <140 | 5.0 | 9,631 non-DM pts, of which 2,646 w/eGFR 20–60 (71.8±20.7 vs. 71.7±20.5) | HR for all: 0.75 (95% CI, 0.64–0.89) |
| SPRINT CKD subgroup9 (2017) | SBP <120 | SBP <140 | 3.3 | 2,646 non-DM pts w/eGFR 20–60 (47.9±9.5) | CV events HR: 0.81 (95% CI, 0.63–1.05); death HR: 0.72 (95% CI, 0.53–0.99) |
Abbreviations: CI, confidence interval; AASK, African American Study of Kidney Disease and Hypertension; ACCORD, Action to Control Cardiovascular Risk in Diabetes; BP, blood pressure; CKD-5D, dialysis-dependent chronic kidney disease; CV, cardiovascular; eGFR, estimated glomerular filtration rate (in mL/min/1.73); HR, hazard ratio; MAP, mean arterial pressure; MDRD, modification of diet in renal disease; NDD-CKD, non-dialysis-dependent chronic kidney disease; REIN-2, Ramipril Efficacy In Nephropathy-2; RR, relative risk; SBP, systolic blood pressure; sCr, serum creatinine (in mg/dL); SD, standard deviation; SPRINT, Systolic Blood Pressure Intervention Trial; NR, not reported; pts, patients.
A MAP of 92 is lower than the blood pressure target of 130/80 mm Hg, traditionally recommended for CKD patients; a MAP of 107 mm Hg corresponds a blood pressure target of 140/90 mm Hg; HTN, hypertension.
units are mm Hg