Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Feb;28(2):671-677.
doi: 10.1681/ASN.2016030326. Epub 2016 Aug 11.

BP Control and Long-Term Risk of ESRD and Mortality

Elaine Ku  1   2 , Jennifer Gassman  3 , Lawrence J Appel  4 , Miroslaw Smogorzewski  5 , Mark J Sarnak  6 , David V Glidden  7 , George Bakris  8 , Orlando M Gutiérrez  9   10 , Lee A Hebert  11 , Joachim H Ix  12 , Janice Lea  13 , Michael S Lipkowitz  14 , Keith Norris  15 , David Ploth  16 , Velvie A Pogue, Stephen G Rostand  9 , Edward D Siew  17 , Mohammed Sika  17 , C Craig Tisher  18 , Robert Toto  19 , Jackson T Wright Jr  20 , Christina Wyatt  21 , Chi-Yuan Hsu  22
Affiliations

BP Control and Long-Term Risk of ESRD and Mortality

Elaine Ku et al. J Am Soc Nephrol. 2017 Feb.

Abstract

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 Renal Disease (MDRD) trial. Here, we determined the risk of ESRD and mortality during extended follow-up of the African American Study of Kidney Disease and Hypertension (AASK) trial. We linked 1067 former AASK participants with CKD previously 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 had ESRD and 475 deaths occurred during a median follow-up 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 to 0.98; P=0.03), respectively. In meta-analyses of individual-level data from the 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 usual BP arms. Our findings suggest that, during long-term follow-up, strict BP control does not delay the onset of ESRD but may reduce the relative risk of death in CKD.

Keywords: ESRD; ckd; hypertension.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Long-term follow-up in AASK. Distribution of ESRD and deaths by BP study arm assignment in AASK.
Figure 2.
Figure 2.
Long-term risk of adverse outcomes in AASK. Risk of (A) ESRD and (B) death during long–term extended follow-up of participants in the AASK.
See this image and copyright information in PMC

References

    1. Klahr S, Levey AS, Beck GJ, Caggiula AW, Hunsicker L, Kusek JW, Striker G; Modification of Diet in Renal Disease Study Group : The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal disease. N Engl J Med 330: 877–884, 1994 - PubMed
    1. Ruggenenti P, Perna A, Loriga G, Ganeva M, Ene-Iordache B, Turturro M, Lesti M, Perticucci E, Chakarski IN, Leonardis D, Garini G, Sessa A, Basile C, Alpa M, Scanziani R, Sorba G, Zoccali C, Remuzzi G; REIN-2 Study Group : Blood-pressure control for renoprotection in patients with non-diabetic chronic renal disease (REIN-2): Multicentre, randomised controlled trial. Lancet 365: 939–946, 2005 - PubMed
    1. Wright JT Jr., Bakris G, Greene T, Agodoa LY, Appel LJ, Charleston J, Cheek D, Douglas-Baltimore JG, Gassman J, Glassock R, Hebert L, Jamerson K, Lewis J, Phillips RA, Toto RD, Middleton JP, Rostand SG; African American Study of Kidney Disease and Hypertension Study Group : Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease: Results from the AASK trial. JAMA 288: 2421–2431, 2002 - PubMed
    1. ESH/ESC Task Force for the Management of Arterial Hypertension : 2013 Practice guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC): ESH/ESC Task Force for the Management of Arterial Hypertension. J Hypertens 31: 1925–1938, 2013 - PubMed
    1. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, Lackland DT, LeFevre ML, MacKenzie TD, Ogedegbe O, Smith SC Jr., Svetkey LP, Taler SJ, Townsend RR, Wright JT Jr., Narva AS, Ortiz E: 2014 Evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 311: 507–520, 2014 - PubMed

Publication types