Impact of achieved blood pressure on renal function decline and first stroke in hypertensive patients with chronic kidney disease.

Background. The effect of achieved blood pressure (BP) on first stroke and renal function decline among hypertensive patients with mild to moderate chronic kidney disease (CKD) is still uncertain. Methods. In total, 3230 hypertensive patients with estimated glomerular filtration rate 30-60 mL/min/1.73 m2 and/or proteinuria were included in the present analyses. Eligible participants were randomly assigned to a daily treatment of a combined enalapril 10mg and folic acid 0.8mg tablet or an enalapril 10mg tablet alone. Participants were followed up every 3months. The study outcomes included first stroke and the progression of CKD. Results. The median antihypertensive treatment duration was 4.7 years. Compared with participants with a time-averaged ontreatment systolic blood pressure (SBP) of 135 to-140mmHg, the incidence of total first stroke [1.7% versus 3.3%; hazard ratio (HR), 0.51; 95% confidence interval (CI): 0.26-0.99] and ischemic stroke (1.3% versus 2.8%; HR, 0.46; 95% CI: 0.22-0.98) decreased significantly in those with a time-averaged SBP of-135mmHg. Furthermore, a time-averaged diastolic blood pressure (DBP) of-80mmHg, compared with a time-averaged DBP level of 80 to-90mmHg, was significantly related to a decreased risk of hemorrhagic stroke (0.2% versus 0.9%; HR, 0.18; 95% CI: 0.04-0.80). However, compared with participants with a time-averaged SBP of 135 to-140mmHg, a lower but non-significant trend of CKD progression was found in those with a time-averaged SBP of-130mmHg. Conclusions. A BP treatment level of-135/80mmHg, compared with a BP treatment level of 135-140/80-90mmHg, could lead to a decreased risk of first stroke in hypertensive patients with mild-to-moderate CKD. [ABSTRACT FROM AUTHOR]