Effects of intensive blood pressure control on cardio-kidney outcomes by KDIGO risk categories: a Post Hoc analysis of ACCORD-BP and SPRINT trials.

In 30 seconds

This post hoc secondary analysis of the randomized SPRINT and SPRINT-eligible ACCORD-BP trials examined cardiovascular and kidney outcomes with intensive systolic blood pressure control across low, moderate, and high/very-high KDIGO risk categories. Intensive control was associated with fewer composite cardiovascular events overall (HR 0.68; 95% CI 0.59-0.78), with benefits attenuated at higher KDIGO risk. It also increased composite kidney events (HR 1.88; 95% CI 1.52-2.33), particularly in low- and moderate-risk groups. The association with end-stage kidney disease was not significant (HR 1.05; 95% CI 0.74-1.48).

Key findings

• Intensive blood pressure control reduced composite cardiovascular events overall (HR 0.68; 95% CI 0.59-0.78), with attenuated benefits at higher KDIGO risk (P for interaction = 0.055).
• Composite kidney events increased with intensive control (HR 1.88; 95% CI 1.52-2.33), mainly in low- and moderate-risk groups (P for interaction = 0.04).
• Sustained eGFR decline showed a similar risk-category pattern (P for interaction = 0.03), whereas ESKD did not (HR 1.05; 95% CI 0.74-1.48; P for interaction = 0.71).

Why it matters

The analysis highlights that cardiovascular benefit and kidney outcomes may vary across KDIGO risk categories during intensive blood pressure treatment. Considering both outcome domains is important when interpreting the potential trade-offs of intensive control, particularly because the observed kidney-event increase was not accompanied by a corresponding ESKD effect.

What to keep in mind

This was a post hoc secondary analysis of two trials, so the risk-category comparisons were not the primary randomized analyses.