SPRINT-A Kidney-Centric Narrative Review Recent Advances in Hypertension

Hypertension is a potent cardiovascular risk factor with deleterious end-organ effects and is especially prevalent among patients with chronic kidney disease. The SPRINT (Systolic Blood Pressure Intervention Trial) enrolled patients at an elevated cardiac risk including patients with mild to moderate chronic kidney disease and found that an intensive systolic blood pressure goal of <120 mm Hg significantly reduced the rates of adverse cardiovascular events and all-cause mortality and nonsignificantly reduced the rates of probable dementia; these results were consistent whether one had chronic kidney disease or not. However, results of intensive blood pressure therapy on chronic kidney disease progression were inconclusive, and there was an increased risk of incident chronic kidney disease and acute kidney injury, but the declines in kidney function appear to be hemodynamically driven and reversible. Overall, an intensive blood pressure target is effective in reducing cardiovascular disease and all-cause mortality and may reduce the risk of probable dementia in patients with mild to moderate chronic kidney disease. More studies are needed to determine its long-term effects on kidney function.

Automated summary

Intensive blood pressure lowering significantly reduces cardiovascular events and all-cause mortality in patients with chronic kidney disease, and may also lower the risk of probable dementia. However, the effects on kidney disease progression are inconclusive and more studies are needed to evaluate long-term impacts. Additionally, there is a risk of incident chronic kidney disease and acute kidney injury with intensive blood pressure therapy, but declines in kidney function seem to be reversible and driven by hemodynamics.