Background The public health significance of the reported higher incidence of chronic kidney disease (CKD) with intensive systolic blood pressure (SBP) lowering is unclear. Objective To examine the effects of intensive SBP lowering on kidney and cardiovascular outcomes and contrast its apparent beneficial and adverse effects. Design Subgroup analyses of SPRINT (Systolic Blood Pressure Intervention Trial). (ClinicalTrials.gov: NCT01206062). Setting Adults with high blood pressure and elevated cardiovascular risk. Participants 6662 participants with a baseline estimated glomerular filtration rate (eGFR) of at least 60 mL/min/1.73 m2. Intervention Random assignment to an intensive or standard SBP goal (120 or 140 mm Hg, respectively). Measurements Differences in mean eGFR during follow-up (estimated with a linear mixed-effects model), prespecified incident CKD (defined as a >30% decrease in eGFR to a value <60 mL/min/1.73 m2), and a composite of all-cause death or cardiovascular event, with surveillance every 3 months. Results The difference in adjusted mean eGFR between the intensive and standard groups was -3.32 mL/min/1.73 m2 (95% CI, -3.90 to -2.74 mL/min/1.73 m2) at 6 months, was -4.50 mL/min/1.73 m2 (CI, -5.16 to -3.85 mL/min/1.73 m2) at 18 months, and remained relatively stable thereafter. An incident CKD event occurred in 3.7% of participants in the intensive group and 1.0% in the standard group at 3-year follow-up, with a hazard ratio of 3.54 (CI, 2.50 to 5.02). The corresponding percentages for the composite of death or cardiovascular event were 4.9% and 7.1% at 3-year follow-up, with a hazard ratio of 0.71 (CI, 0.59 to 0.86). Limitation Long-term data were lacking. Conclusion Intensive SBP lowering increased risk for incident CKD events, but this was outweighed by cardiovascular and all-cause mortality benefits. Primary Funding Source National Institutes of Health.

中文翻译：

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强化收缩压控制对无肾病患者肾脏和心血管结局的影响：随机试验的二次分析。

背景 报告的慢性肾脏病 (CKD) 高发病率伴有强化收缩压 (SBP) 降低的公共卫生意义尚不清楚。目的 研究强化 SBP 降低对肾脏和心血管结局的影响，并对比其明显的有利和不利影响。SPRINT（收缩压干预试验）的设计亚组分析。（ClinicalTrials.gov：NCT01206062）。设置患有高血压和心血管风险升高的成年人。参与者 6662 名参与者的基线估计肾小球滤过率 (eGFR) 至少为 60 mL/min/1.73 m2。干预 随机分配到强化或标准 SBP 目标（分别为 120 或 140 mm Hg）。测量 随访期间平均 eGFR 的差异（使用线性混合效应模型估计），预先指定的 CKD 事件（定义为 eGFR 降低 >30% 至 <60 mL/min/1.73 m2），以及全因死亡或心血管事件的复合，每 3 个月监测一次。结果 6 个月时强化组和标准组之间调整后的平均 eGFR 差异为 -3.32 mL/min/1.73 m2（95% CI，-3.90 至 -2.74 mL/min/1.73 m2），为 -4.50 mL/min/ 18 个月时为 1.73 m2（CI，-5.16 至 -3.85 mL/min/1.73 m2），此后保持相对稳定。在 3 年的随访中，强化组 3.7% 的参与者和标准组 1.0% 的参与者发生了 CKD 事件，风险比为 3.54（CI，2.50 至 5.02）。在 3 年的随访中，死亡或心血管事件复合事件的相应百分比分别为 4.9% 和 7.1%，风险比为 0.71（CI，0.59 至 0.86）。局限性 缺乏长期数据。结论 强化 SBP 降低了 CKD 事件风险的增加，但心血管和全因死亡率的益处超过了这一点。主要资金来源美国国立卫生研究院。