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Reducing Systolic Blood Pressure Benefits Patients with Chronic Kidney Disease

Physicians for years have considered 120-150 mmHg as the ‘normal’ range for systolic blood pressure (BP). However according to results derived from a recent clinical trial, maintaining this conventional target BP might not be enough for patients suffering from chronic kidney disease (CKD). A new study, published in the Journal of the American Society of Nephrology (JASN), shows that lowering the systolic blood pressure (SBP) to <120 mmHg prevents cardiovascular complications and early death in CKD patients.

With a goal to determine the appropriate target BP in CKD patients, researchers from University of Utah Health analyzed data from the Systolic Blood Pressure Intervention Trial (SPRINT), initially published in 2015. This trial involved individuals aged ≥50 years with SBP of ≥130 mmHg and at least one additional cardiovascular disease risk factor. Initial results from SPRINT showed that intensive lowering of the SBP to <120 mmHg significantly reduced risk of cardiac complications and death, suggesting that the current guideline for SBP might have to be reevaluated. However, researchers observed some adverse events associated with intensive blood pressure management such as fainting and acute kidney abnormalities, calling for further investigation.

This prompted Dr. Alfred K. Cheung and his colleagues to examine a subgroup of SPRINT with CKD. Interestingly, this study showed that intensive lowering of SBP to <120 mmHg benefited individuals who had CKD similar to those without the condition. CKD patients whose SBP was lowered beyond the convention experienced a 19% reduction in risk of developing an adverse cardiovascular outcome and a 28% reduction in risk of premature death. A slight decline in kidney function (but no serious adverse events) was seen only in patients ≥75 years.

Since SPRINT participants were only followed for an average of just over 3 years, long-term and side effects of lowering SBP on vital organs have yet to be determined. Nonetheless, this study shows provocative data that might influence new medical guidelines for treating hypertensive CKD patients.

 - Written by Vrushali Mangale