Background During intensive BP lowering, acute declines in renal function are common, thought to be hemodynamic, and potentially reversible. We previously showed that acute declines in renal function ≥20% during intensive BP lowering were associated with higher risk of ESRD. Here, we determined whether acute declines in renal function during intensive BP lowering were associated with mortality risk among 1660 participants of the African American Study of Kidney Disease and Hypertension and the Modification of Diet in Renal Disease Trial.

Methods We used Cox models to examine the association between percentage decline in eGFR (<5%, 5% to <20%, or ≥20%) between randomization and months 3–4 of the trials (period of therapy intensification) and death.

Results In adjusted analyses, compared with a <5% eGFR decline in the usual BP arm (reference), a 5% to <20% eGFR decline in the intensive BP arm was associated with a survival benefit (hazard ratio [HR], 0.77; 95% confidence interval [95% CI], 0.62 to 0.96), but a 5% to <20% eGFR decline in the usual BP arm was not (HR, 1.01; 95% CI, 0.81 to 1.26; P<0.05 for the interaction between intensive and usual BP arms for mortality risk). A ≥20% eGFR decline was not associated with risk of death in the intensive BP arm (HR, 1.18; 95% CI, 0.86 to 1.62), but it was associated with a higher risk of death in the usual BP arm (HR, 1.40; 95% CI, 1.04 to 1.89) compared with the reference group.

Conclusions Intensive BP lowering was associated with a mortality benefit only if declines in eGFR were <20%.

背景技术在血压急剧下降期间，肾功能的急性下降很普遍，被认为具有血液动力学特性，并且可能是可逆的。我们以前的研究表明，在强烈降低BP的过程中，肾功能急性下降≥20％与ESRD的风险较高有关。在这里，我们确定了在BP剧烈降低期间肾功能的急性下降是否与1660名非裔美国人肾脏疾病和高血压研究以及肾脏疾病试验中饮食调整的参与者的死亡风险相关。

方法我们使用Cox模型检查了随机分组与试验3–4个月（强化治疗期间）与死亡之间eGFR百分比下降（<5％，5％至<20％或≥20％）之间的关联。

结果在调整后的分析中，与普通BP组（参考）的eGFR下降<5％相比，强化BP组eGFR下降5％至<20％与生存获益相关（危险比[HR]为0.77 ； 95％置信区间[95％CI]，从0.62至0.96），但正常BP组的eGFR下降5％至<20％（HR，1.01； 95％CI，0.81至1.26；P <0.05强化和常规BP部门之间因死亡风险的相互作用）。≥20％eGFR下降与强化BP组的死亡风险无关（HR，1.18； 95％CI，0.86至1.62），但与普通BP组的较高死亡风险有关（HR，与参考组相比为1.40； 95％CI，1.04至1.89）。

结论仅当eGFR的下降<20％时，降压才能降低血压与死亡率。