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Intensive BP Therapy May Not Slow CKD Progression

Appears no better than standard therapy in black patients, but those with proteinuria may benefit

WEDNESDAY, Sept. 1 (HealthDay News) -- Intensive blood pressure (BP) therapy does not affect hypertensive chronic kidney disease (CKD) progression in most black patients compared to standard BP control, but a potential benefit has been seen for some patients with proteinuria, according to a study in the Sept. 2 issue of the New England Journal of Medicine.

Lawrence J. Appel, M.D., of the Johns Hopkins Medical Institutions in Baltimore, and colleagues randomized 1,094 black patients with hypertensive CKD to either intensive or standard treatment for high BP. After completing the trial phase, patients were enrolled in a cohort phase (BP target below 130/80 mm Hg) and followed for CKD progression, defined as a doubling of the serum creatinine level, a diagnosis of end-stage renal disease, or death. The patients were followed between 8.8 and 12.2 years.

During both trial and cohort phases, the researchers found no significant difference between intensive and standard treatment for disease progression. However, the effects varied with the baseline level of proteinuria, with a potential benefit seen for patients with a protein-to-creatinine ratio greater than 0.22 (hazard ratio, 0.73).

"Subgroup analyses from our study suggest that a lower BP target may retard disease progression in some patients with hypertensive CKD, but the evidence for this benefit is limited to patients with a protein-to-creatinine ratio of more than 0.22 at baseline," the authors write.

The research was supported in part by King Pharmaceuticals, Pfizer, AstraZeneca, GlaxoSmithKline, Forest Laboratories, Pharmacia, and Upjohn; these companies also provided antihypertensive medications for the study.

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