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BP Reduction, Kidney Function Decline, and Cardiovascular Events in Patients without CKD.

dc.contributor.authorMagriço, R
dc.contributor.authorVieira, M
dc.contributor.authorDias, C
dc.contributor.authorLeitão, L
dc.contributor.authorNeves, J
dc.date.accessioned2019-01-15T16:01:09Z
dc.date.available2019-01-15T16:01:09Z
dc.date.issued2018
dc.description.abstractBACKGROUND AND OBJECTIVES: In the Systolic Blood Pressure Intervention Trial (SPRINT), intensive systolic BP treatment (target <120 mm Hg) was associated with fewer cardiovascular events and higher incidence of kidney function decline compared with standard treatment (target <140 mm Hg). We evaluated the association between mean arterial pressure reduction, kidney function decline, and cardiovascular events in patients without CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We categorized patients in the intensive treatment group of the SPRINT according to mean arterial pressure reduction throughout follow-up: <20, 20 to <40, and ≥40 mm Hg. We defined the primary outcome as kidney function decline (≥30% reduction in eGFR to <60 ml/min per 1.73 m2 on two consecutive determinations at 3-month intervals), and we defined the secondary outcome as cardiovascular events. In a propensity score analysis, patients in each mean arterial pressure reduction category from the intensive treatment group were matched with patients from the standard treatment group to calculate the number needed to treat regarding cardiovascular events and the number needed to harm regarding kidney function decline. RESULTS: In the intensive treatment group, 1138 (34%) patients attained mean arterial pressure reduction <20 mm Hg, 1857 (56%) attained 20 to <40 mm Hg, and 309 (9%) attained ≥40 mm Hg. Adjusted hazard ratios for kidney function decline were 2.10 (95% confidence interval, 1.22 to 3.59) for mean arterial pressure reduction between 20 and 40 mm Hg and 6.22 (95% confidence interval, 2.75 to 14.08) for mean arterial pressure reduction ≥40 mm Hg. In propensity score analysis, mean arterial pressure reduction <20 mm Hg presented a number needed to treat of 44 and a number needed to harm of 65, reduction between 20 and <40 mm Hg presented a number needed to treat of 42 and a number needed to harm of 35, and reduction ≥40 mm Hg presented a number needed to treat of 95 and a number needed to harm of 16. CONCLUSIONS: In the intensive treatment group of SPRINT, larger declines in mean arterial pressure were associated with higher incidence of kidney function decline. Intensive treatment seemed to be less favorable when a larger reduction in mean arterial pressure was needed to attain the BP target.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationClin J Am Soc Nephrol. 2018 Jan 6;13(1):73-80pt_PT
dc.identifier.doi10.2215/CJN.05510517pt_PT
dc.identifier.issn1555-905X
dc.identifier.urihttp://hdl.handle.net/10400.10/2073
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherAmerican Society of Nephrologypt_PT
dc.relation.publisherversionhttps://cjasn.asnjournals.org/content/clinjasn/13/1/73.full.pdfpt_PT
dc.subjectChronic kidney diseasept_PT
dc.subjectChronic kidney diseasept_PT
dc.subjectHypertensionpt_PT
dc.titleBP Reduction, Kidney Function Decline, and Cardiovascular Events in Patients without CKD.pt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.conferencePlaceWashington, D.C.pt_PT
oaire.citation.endPage80pt_PT
oaire.citation.startPage73pt_PT
oaire.citation.titleClinical Journal of the American Society of Nephrologypt_PT
oaire.citation.volume13pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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