Supplemental Digital Content is available in the text. Lowering blood pressure (BP) can lead to an initial decline in estimated glomerular filtration rate (eGFR). However, there is debate how much eGFR decline is acceptable. We performed a post hoc analysis of ACCORD-BP (Action to Control Cardiovascular Risk in Diabetes-Blood Pressure) and SPRINT (Systolic Blood Pressure Intervention Trial), which randomized patients to intensive or standard systolic BP-targets. We determined the relation between initial decline in mean arterial pressure and eGFR. Subsequently, we stratified patients to BP-target and initial eGFR decrease and assessed the relation with annual eGFR decline after 1 year. A total of 13 266 patients with 41 126 eGFR measurements were analyzed. Up to 10 mm Hg of BP-lowering, eGFR did not change. Hereafter, there was a linear decrease of 3.4% eGFR (95% CI, 2.9%–3.9%) per 10 mm Hg mean arterial pressure decrease. The observed eGFR decline based on 95% of the subjects varied from 26% after 0 mm Hg to 46% with a 40 mm Hg mean arterial pressure decrease. There was no difference in eGFR slope (P=0.37) according to initial eGFR decline and BP-target, with a decrease of 1.24 (95% CI, 1.09–1.39), 1.20 (95% CI, 0.97–1.43), and 1.14 (95% CI, 0.77–1.50) in the 5%, 5% to 20%, and >20% stratum during intensive and 0.95 (95% CI, 0.81–1.09), 1.23 (95% CI, 0.97–1.49), and 1.17 (95% CI, 0.65–1.69) mL/minute per 1.73 m2 per year during standard treatment. In patients at high cardiovascular risk with and without diabetes mellitus, we found no association between initial eGFR and annual eGFR decline during BP-lowering treatment. Our results support that an eGFR decrease up to 20% after BP lowering can be accepted and suggest that the limit can be extended up to 46% depending on the achieved BP reduction. Registration— URL: https://www.clinicaltrials.gov; Unique identifier: NCT00000620, NCT01206062.

中文翻译：

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强化抗高血压治疗期间初始估计的肾小球滤过率下降和长期肾功能

补充数字内容在文本中可用。降低血压 (BP) 可导致估计肾小球滤过率 (eGFR) 的初始下降。然而，eGFR 下降多少是可以接受的存在争议。我们对 ACCORD-BP（控制糖尿病血压心血管风险的行动）和 SPRINT（收缩压干预试验）进行了事后分析，将患者随机分配到强化或标准收缩压目标。我们确定了平均动脉压初始下降与 eGFR 之间的关系。随后，我们将患者分层为 BP 目标和初始 eGFR 下降，并评估与 1 年后每年 eGFR 下降的关系。总共分析了 13 266 名患者的 41 126 次 eGFR 测量值。最高 10 mmHg 的血压降低，eGFR 没有改变。此后，平均动脉压每降低 10 mmHg，eGFR 线性降低 3.4%（95% CI，2.9%–3.9%）。根据 95% 的受试者观察到的 eGFR 下降从 0 毫米汞柱后的 26% 到平均动脉压下降 40 毫米汞柱后的 46%。根据初始 eGFR 下降和 BP 目标，eGFR 斜率 (P=0.37) 没有差异，下降了 1.24（95% CI，1.09-1.39）、1.20（95% CI，0.97-1.43）和 1.14 (95% CI, 0.77–1.50) 在 5%, 5% 到 20%, 和 >20% 强化期间和 0.95 (95% CI, 0.81–1.09), 1.23 (95% CI, 0.97–1.49)标准治疗期间每年每 1.73 平方米 1.17 (95% CI, 0.65–1.69) mL/分钟。在有或没有糖尿病的高心血管风险患者中，我们发现在降压治疗期间初始 eGFR 和年度 eGFR 下降之间没有关联。我们的结果支持在血压降低后 eGFR 降低高达 20% 是可以接受的，并建议根据实现的血压降低，该限制可以延长至 46%。注册——网址：https://www.clinicaltrials.gov；唯一标识符：NCT00000620、NCT01206062。