Intensive systolic blood pressure control in patients with or without worsening renal function.

Aims: Intensive systolic blood pressure (BP) control is associated with a lower risk of cardiovascular disease (CVD) but an increased risk of worsening renal function (WRF). This study aimed to investigate whether intensive BP control should be continued after WRF.

Methods: We performed a post hoc analysis of SPRINT (Systolic Blood Pressure Intervention Trial). WRF was defined as an eGFR decline of ≥30% during follow-up from baseline. The associations between WRF, efficacy and safety outcomes, and BP treatment were evaluated using time updated Cox proportional hazard models.

Results: Among 9,211 participants included in this analysis, 1,310 participants (14.2%) experienced WRF during follow-up. The intensive BP treatment significantly reduced the risk of the primary outcome compared with the standard BP treatment among patients with WRF (HR: 0.54; 95% CI: 0.32-0.90) and without WRF (HR: 0.82; 95% CI: 0.68-0.98; P  interaction = 0.224). In addition, the intensive BP treatment significantly reduced the risk of all-cause death among patients with WRF (HR: 0.40; 95% CI: 0.23-0.68), but not among patients without WRF (HR: 0.84; 95% CI: 0.67-1.07; P  interaction = 0.046). Risks of safety events were similar between BP treatment groups among patients with and without WRF. Results were similar among participants who experienced WRF early or late during the intervention.

Conclusion: Intensive BP treatment increased the risk of WRF compared with standard BP treatment. However, intensive BP treatment was associated with reduced risks of CVD and all-cause mortality compared with standard BP treatment in patients experiencing WRF, without increasing adverse events.