Influence of Prediabetes on the Effects of Intensive Systolic Blood Pressure Control on Kidney Events

Abstract

Background: More than one-third of US adults have prediabetes, which is typically accompanied by hypertension.

Methods: We examined whether prediabetes modified the effects of intensive systolic blood pressure (SBP) lowering on the incidence of chronic kidney disease (CKD) and acute kidney injury (AKI) events in a post-hoc analysis of the Systolic Blood Pressure Intervention Trial (SPRINT). Diabetes was a SPRINT exclusion criterion. We defined normoglycemia and prediabetes as fasting plasma glucose <100 mg/dl and ≥100 mg/dl, respectively.

Results: Of the 9,323 participants included in this analysis, 3,898 (41.8%) had prediabetes and the rest (5,425) had normoglycemia. In participants with baseline estimated glomerular filtration rate (eGFR) ≥60 ml/min/1.73 m2, incident CKD was defined as a ≥30% decline in eGFR to below 60 ml/min/1.73 m2 with repeat confirmation. AKI events were identified clinically. In the non-CKD participants (n = 6,678), there were 164 incident CKD events. The hazard ratios (HRs) for incident CKD for intensive SBP goal (<120 mm Hg) vs. standard SBP goal (<140 mm Hg) in the normoglycemia (HR: 3.25, 95% CI: 2.03, 5.19) and prediabetes (HR: 3.90, 95% CI: 2.17, 7.02) groups were similar (interaction P value 0.64). In the entire analytic cohort (N = 9,323), there were 310 AKI events. AKI HRs for intensive vs. standard SBP in the normoglycemia (HR: 1.59, 95% CI: 1.17, 2.15) and prediabetes (HR: 1.74, 95% CI: 1.22, 2.48) groups were also similar (interaction P value 0.71).

Conclusions: Prediabetes was highly prevalent, but there was no evidence that prediabetes modified the effects of SPRINT intervention on kidney events.CLINICAL TRIALS REGISTRATIONNCT01206062.

Keywords: acute kidney injury; blood pressure; chronic kidney disease; hypertension; prediabetes.

© Published by Oxford University Press on behalf of American Journal of Hypertension Ltd 2019.

Figures

Figure 1.

Incidence of CKD* in the non-CKD Subgroup. (a) Kaplan–Meier failure plots. (b) Absolute risk differences at 3 years. (c) Hazard ratio for entire follow-up. CKD, chronic kidney disease (eGFR < 60 ml/min/1.73 m2); FPG, fasting plasma glucose; non-CKD, no chronic kidney disease (eGFR ≥ 60 ml/min/1.73 m2); Std, standard; Int, intensive.

Figure 2.

Incidence of AKI* in the entire cohort. (a) Kaplan–Meier failure plots. (b) Absolute risk differences at 3 years. (c) Hazard ratio for entire follow-up. AKI, acute kidney injury; FPG, fasting plasma glucose; Int, intensive; Std, standard.