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Intensive BP control ‘has no effect on CKD progression’

Intensive blood pressure control has no effect on the progression of hypertensive chronic kidney disease in black patients, a randomised controlled trial has shown.

US researchers randomly assigned 1,094 black patients with hypertensive CKD to receive either intensive or standard blood pressure control to a target of 130/80 mm Hg or 140/90 mm Hg respectively.

Patients were also randomised to one of three initial therapies: ramipril, metoprolol or amlodipine. If a target could not be reached with the highest tolerated dose of the first drug, other antihypertensives were sequentially added.

Among all patients and across both phases of the study, there was no significant difference between the groups in the primary outcome, a doubling of the serum creatinine level, end-stage renal disease or death, which was 9% less likely to occur in the intensive-control group than the standard-control group.

But study leader Professor Lawrence Appel, professor of internal medicine at the John Hopkins University in Baltimore, concluded: ‘Results differed according to the baseline protein-to-creatinine ratio. In patients with a PCR of more than 0.22, intensive blood-pressure control significantly retarded disease progression. [But] it had no significant or consistent effect in patients with a lower PCR.'

N Engl J Med 2010; 363: 918-29

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