title: BP Control and Long-Term Risk of ESRD and Mortality.
abstract: We recently showed an association between strict BP control and lower mortality risk during two decades of follow-up of prior participants in the Modification of Diet in Renal Disease (MDRD) trial. Here, we determined the risk of ESRD and mortality during extended follow-up of the African American Study of Kidney Disease and Hypertension (AASK) trial. We linked 1067 former AASK participants with CKD previously randomized to strict or usual BP control (mean arterial pressure ≤92 mmHg or 102-107 mmHg, respectively) to the US Renal Data System and Social Security Death Index; 397 patients had ESRD and 475 deaths occurred during a median follow-up of 14.4 years from 1995 to 2012. Compared with the usual BP arm, the strict BP arm had unadjusted and adjusted relative risks of ESRD of 0.92 (95% confidence interval [95% CI], 0.75 to 1.12) and 0.95 (95% CI, 0.78 to 1.16; P=0.64), respectively, and unadjusted and adjusted relative risks of death of 0.92 (95% CI, 0.77 to 1.10) and 0.81 (95% CI, 0.68 to 0.98; P=0.03), respectively. In meta-analyses of individual-level data from the MDRD and the AASK trials, unadjusted relative risk of ESRD was 0.88 (95% CI, 0.78 to 1.00) and unadjusted relative risk of death was 0.87 (95% CI, 0.76 to 0.99) for strict versus usual BP arms. Our findings suggest that, during long-term follow-up, strict BP control does not delay the onset of ESRD but may reduce the relative risk of death in CKD.
authors: Department of Medicine, Division of Nephrology, elaine.ku@ucsf.edu.|Department of Pediatrics, Division of Pediatric Nephrology, and.
authors: Elaine
authors: E
authors: Ku
authors: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.
authors: Jennifer
authors: J
authors: Gassman
authors: Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland.
authors: Lawrence J
authors: LJ
authors: Appel
authors: Department of Medicine, Division of Nephrology and Hypertension, University of Southern California, Los Angeles, California.
authors: Miroslaw
authors: M
authors: Smogorzewski
authors: Department of Medicine, Division of Nephrology, Tufts Medical Center, Boston, Massachusetts.
authors: Mark J
authors: MJ
authors: Sarnak
authors: Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.
authors: David V
authors: DV
authors: Glidden
authors: Department of Medicine, Comprehensive Hypertension Center, University of Chicago Medicine, Chicago, Illinois.
authors: George
authors: G
authors: Bakris
authors: Departments of Medicine and.|Epidemiology, Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama.
authors: Orlando M
authors: OM
authors: Gutiérrez
authors: Department of Internal Medicine, Division of Nephrology, Ohio State University, Columbus, Ohio.
authors: Lee A
authors: LA
authors: Hebert
authors: Department of Medicine, Division of Nephrology, University of California, San Diego, San Diego, California.
authors: Joachim H
authors: JH
authors: Ix
authors: Department of Medicine, Division of Renal Medicine, Emory University, Atlanta, Georgia.
authors: Janice
authors: J
authors: Lea
authors: Department of Medicine, Division of Nephrology, Georgetown University, Washington DC.
authors: Michael S
authors: MS
authors: Lipkowitz
authors: Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, Los Angeles, California.
authors: Keith
authors: K
authors: Norris
authors: Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, South Carolina.
authors: David
authors: D
authors: Ploth
authors: Velvie A
authors: VA
authors: Pogue
authors: Departments of Medicine and.
authors: Stephen G
authors: SG
authors: Rostand
authors: Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt Center for Kidney Disease, Vanderbilt University Medical Center, Nashville, Tennessee.
authors: Edward D
authors: ED
authors: Siew
authors: Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt Center for Kidney Disease, Vanderbilt University Medical Center, Nashville, Tennessee.
authors: Mohammed
authors: M
authors: Sika
authors: Department of Medicine, Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, Florida.
authors: C Craig
authors: CC
authors: Tisher
authors: Department of Internal Medicine, Division of Nephrology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors: Robert
authors: R
authors: Toto
authors: Department of Internal Medicine, Division of Nephrology and Hypertension, Case Western Reserve University, Cleveland, Ohio; and.
authors: Jackson T
authors: JT
authors: Wright
authors: Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, New York.
authors: Christina
authors: C
authors: Wyatt
authors: Department of Medicine, Division of Nephrology.
authors: Chi-Yuan
authors: CY
authors: Hsu
mesh_terms: D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000517:prevention & control*; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013997:Time Factors
keywords: ESRD; ckd; hypertension