Table 9.2Cardiovascular and renal outcomes according to SBP or MAP control in adults with either diabetic or nondiabetic CKD stratified by baseline urinary protein excretion rate (95% confidence interval)

OutcomeNondiabetic CKDDiabetic CKD
<1 g/day proteinuria>1 g/day proteinuria<1 g/day proteinuria>1 g/day proteinuria
All-cause mortalityNS difference intense vs. usual MAP control (AASK)HR 0.62 (0.45–0.85), p=0.003
SBP 134–154 mmHg vs. ≤133 mmHg
(US vet)
RR 3.05 (1.80–5.17), p<0.0001
SBP ≤120 mmHg vs. SBP >120 mmHg (IDNT*)
Cardiovascular mortalityNS difference intense vs. usual MAP control (AASK)RR 4.06 (2.11–7.80), p<0.0001
SBP ≤120 mmHg vs. SBP >120 mmHg (IDNT*)
Congestive heart failureRR 1.80 (1.17–2.86), p=0.008
SBP ≤120 mmHg vs. SBP >120 mmHg (IDNT*)
Myocardial infarctionNS ≤120 vs. >120 (IDNT*)
StrokeHR 2.26 (1.16–4.41) SBP <120 mmHg vs. SBP 120–129 mmHg (ARIC + CHS CKD cohort, 18% diabetic, no proteinuria data)NS ≤120 vs. >120 (IDNT*)
Decline in GFR or creatinine clearanceNS difference intense vs. usual MAP control (MDRD)
NS difference intense vs. usual MAP control (AASK) SBP not predictive (Leiden 85-Plus; 16% diabetic, no proteinuria data)
Intense MAP control (GFR decline 5.5 ml/min/ year) vs. usual MAP control (GFR decline 8 ml/min/year) (no p value) (MDRD) NS difference intense vs. usual MAP control (REIN-2)
Doubling serum Creatinine, ESRD, or deathNS risk SBP
130–139 mmHg vs. SBP <130 mmHg
HR 1.49 (1.18–1.90), p=0.001
SBP 140–159 mmHg vs. SBP <130 mmHg (RENAAL*)
ESRD or deathNS risk intense vs. usual MAP control (MDRD-GFR 13–24 ml/min/1.73 m2)NS difference in risk
SBP 130–139 mmHg vs. SBP <130 mmHg
HR 1.33 (1.02–1.72), p=0.03
SBP 140–159 mmHg vs. SBP <130 mmHg vs. (RENAAL*)
ESRDNS risk intense vs. usual MAP control (AASK)NS risk intense vs. usual MAP control (REIN-2)NS risk SBP
130–139 mmHg vs. SBP <130 mmHg
HR 1.52 (1.07–2.15), p=0.02
SBP 140–159 mmHg vs. SBP <130 mmHg (RENAAL*)
Doubling serum creatinine or ESRDNS risk SBP <110 to >160 mmHg (Jafar meta-analysis)NS risk SBP 120–129 vs. 110–119 mmHg RR 4.5, no CI given SBP 130–139 mmHg vs. 110–119 mmHg (Jafar meta-analysis)
ProteinuriaProteinuria intense MAP control (AASK)
Proteinuria intense MAP control (MDRD*)
NS difference intense vs. usual MAP control (REIN-2)
Proteinuria intense MAP control (MDRD*)
*

Post-hoc analysis.

From: 9, Blood pressure control

Cover of Chronic Kidney Disease
Chronic Kidney Disease: National Clinical Guideline for Early Identification and Management in Adults in Primary and Secondary Care.
NICE Clinical Guidelines, No. 73.
National Collaborating Centre for Chronic Conditions (UK).
Copyright © 2008, Royal College of Physicians of London.

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