The effect of a lower target blood pressure on the progression of kidney disease: long-term follow-up of the modification of diet in renal disease study.
BACKGROUND
Hypertension is a risk factor for progression of chronic kidney disease. The optimal blood pressure to slow progression is unknown.


OBJECTIVE
To evaluate the effects of a low target blood pressure on kidney failure and all-cause mortality.


METHODS
Long-term follow-up of the Modification of Diet in Renal Disease Study, a randomized, controlled trial conducted from 1989 to 1993.


METHODS
15 outpatient nephrology practices.


METHODS
840 persons with predominantly nondiabetic kidney disease and a glomerular filtration rate of 13 to 55 mL/min per 1.73 m2.


METHODS
A low target blood pressure (mean arterial pressure < 92 mm Hg) or a usual target blood pressure (mean arterial pressure < 107 mm Hg).


METHODS
After the randomized trial was completed, kidney failure (defined as initiation of dialysis or kidney transplantation) and a composite outcome of kidney failure or all-cause mortality were ascertained through 31 December 2000.


RESULTS
Kidney failure occurred in 554 participants (66%), and the composite outcome occurred in 624 participants (74%). After Cox proportional hazards modeling and intention-to-treat analysis, the adjusted hazard ratios were 0.68 (95% CI, 0.57 to 0.82; P < 0.001) for kidney failure and 0.77 (CI, 0.65 to 0.91; P = 0.0024) for the composite outcome in the low target blood pressure group compared with the usual target blood pressure group. Evidence was insufficient to conclude that the benefit of a low target blood pressure differed according to the cause of kidney disease, baseline glomerular filtration rate, or degree of proteinuria.


CONCLUSIONS
The exact mechanism underlying the benefit of a low target blood pressure is unknown.


CONCLUSIONS
Assignment to a low target blood pressure slowed the progression of nondiabetic kidney disease in patients with a moderately to severely decreased glomerular filtration rate.
Sarnak
Mark J
MJ
Division of Nephrology, Tufts-New England Medical Center, Boston, Massachusetts 02111, USA. msarnak@tufts-nemc.org
Greene
Tom
T
Wang
Xuelei
X
Beck
Gerald
G
Kusek
John W
JW
Collins
Allan J
AJ
Levey
Andrew S
AS
D000293:Adolescent; D000328:Adult; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D007674:Kidney Diseases / Q000178:diet therapy / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000517:prevention & control*; D012680:Sensitivity and Specificity
D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents