Author + information
- Youbao Li,
- Xianhui Qin,
- Xiping Xu,
- Yong Huo,
- Binyan Wang and
- Jianping Li
Background: We aimed to test the impact of achieved blood pressure (BP) on first stroke among hypertensive patients with mild to moderate chronic kidney disease (CKD) in the China Stroke Primary Prevention Trial (CSPPT).
Methods: A total of 3,230 patients with eGFR 30-60ml/min/1.73m2 and/or proteinuria at baseline were included in the current analysis. The primary outcome was a first stroke.
Results: The median antihypertensive treatment duration was 4.7 years. Overall, the risk of stroke decreased with the reduction of time-averaged systolic BP (SBP, per 5mmHg decrement; HR, 0.80; 95%CI: 0.76, 0.84). Compared to patients with time-averaged SBP of 135-≤140mmHg (mean: 137.5±1.4mmHg), the incidence of stroke increased significantly in those with time-averaged SBP >145mmHg (155.4±9.9mmHg; 6.9% vs. 3.3%; HR, 1.76; 95%CI: 1.06, 1.93), and decreased significantly in patients with time-averaged SBP ≤135mmHg (128.9±4.8mmHg; 1.7% vs. 3.3%; HR, 0.51; 95%CI: 0.26, 0.99) during the treatment period. Furthermore, a greater risk reduction was observed in those with time-averaged SBP ≤130mmHg (125.1±3.9mmHg; 1.3% vs. 3.3%; HR, 0.39; 95%CI: 0.15, 0.97). Similar trends were observed for the composite of cardiovascular events and all-cause death. The beneficial effect for stroke with time-averaged SBP ≤135mmHg (vs. 135-≤140mmHg) was consistent across age (<60 vs. ≥60years), sex, baseline SBP (<160 vs. ≥160mmHg), eGFR levels (<90 vs. ≥90ml/min/1.73m2) and study treatment groups (enalapril or enalapril-folic acid).
Conclusions: Among hypertensive patients with mild to moderate CKD, a SBP treatment level of ≤135mmHg (mean: 128.9mmHg), compared with a SBP treatment level of 135-140mmHg (mean: 137.5mmHg), was significantly associated with a lower rate of first stroke.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Assessing the Clinical Impact of Blood Pressure Lowering Therapies
Abstract Category: 33. Prevention: Hypertension
Presentation Number: 1105-034
- 2017 American College of Cardiology Foundation