Lower Systolic Pressure in Hypertension and Renal Function Protection
Greater renal function protection observed with lower systolic blood pressure in patients with hypertension and left ventricular hypertrophy. Analysis conducted during the LIFE study revealed a potential relationship between estimated glomerular filtration rate and average on-treatment systolic blood pressure.
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26thEuropean Meeting on Hypertension and Cardiovascular Protection Paris (France), June 10-13, 2016 LIFE Study: Lower Systolic Pressure Slowed Progression of Renal Dysfunction in Hypertension From ESH 2016 | POS 4C: Sverre E. Kjeldsen, MD Oslo University Hospital, Ullevaal, Oslo, Norway Infomedica Conference Coverage* of 26thEuropean Meeting on Hypertension and Cardiovascular Protection Paris (France), June 10-13, 2016 * Infomedica is an independent medical education provider that produces medical information to healthcare professionals through conference coverage and online educational programs and activities. Powered by Infomedica
26th European Meeting on Hypertension and Cardiovascular Protection Paris (France), June 10-13, 2016 Overview Greater protection of renal function with lower average on- treatment systolic blood pressure (SBP) in patients with hypertension and echocardiographic (ECG)-confirmed left ventricular hypertrophy (LVH) was found in post hoc analysis of the LIFE (Losartan Intervention For Endpoint reduction) study Analysis conducted due to lack of current evidence of benefit of lower blood pressure or antihypertensive treatment on progression of renal dysfunction The relationship between estimated glomerular filtration rate (eGFR) and the average on-treatment SBP was investigated Powered by Infomedica 26th European Meeting on Hypertension and Cardiovascular Protection
26th European Meeting on Hypertension and Cardiovascular Protection Paris (France), June 10-13, 2016 Baseline Characteristics by SBP Group SBP 130 mmHg (n=446) SBP 131-141 mmHg (n=2483) SBP 142 mmHg (n=5849) Variables Age (years) 64.5 7.1 65.9 7.1 67.6 6.9 Sex (% female) 47.1 50.2 56.1 Race (% black) 11.2 6.5 5.5 Diabetes (%) 11.4 10.7 14.2 History of ischemic heart disease (%) 21.1 15.0 16.1 History of myocardial infarction (%) 10.5 6.4 5.7 History of stroke (%) 5.8 3.7 4.5 History of heart failure (%) 4.0 1.3 1.9 History of peripheral vascular disease (%) 6.1 4.8 6.0 Current smoker (%) 21.5 16.8 15.7 Prior antihypertensive treatment (%) 69.5 67.7 74.4 Randomized treatment (% Losartan) 50.4 53.4 48.6 Body mass index (kg/m2) 28.1 5.4 27.9 4.7 28.0 4.8 Serum glucose (mmol) 5.89 2.26 5.91 2.09 6.08 2.23 Total cholesterol (mmol) 5.75 1.22 5.95 1.09 6.10 1.12 HDL cholesterol (mmol) 1.42 0.42 1.49 0.44 1.50 0.44 UACR (mg/mmol) 3.4 7.3 6.1 24.5 8.6 38.3 SBP, systolic blood pressure; UACR, urinary albumin-to-creatinine ratio. Powered by Infomedica 26th European Meeting on Hypertension and Cardiovascular Protection
26th European Meeting on Hypertension and Cardiovascular Protection Paris (France), June 10-13, 2016 Blood Pressure and ECG-LVH By SBP Group at Baseline and Change from Baseline SBP 130 mmHg (n=446) SBP 131-141 mmHg (n=2483) SBP 142 mmHg (n=5849) Variables p value Baseline measurements Systolic BP (mmHg) 162 14 168 13 178 13 <0.001 Diastolic BP (mmHg) 98 9 98 8 98 9 0.714 Cornell product (mm msec) 2678 981 2750 1015 2872 1050 <0.001 Sokolow-Lyon voltage (mm) 29.2 10.3 29.2 10.1 30.4 10.5 <0.001 Change from baseline to last measurement Systolic BP (mmHg) -37.1 19.1 -32.1 18.0 -27.9 20.0 <0.001 Diastolic BP (mmHg) -20.7 9.9 -17.9 9.3 -16.5 10.7 <0.001 Cornell product (mm msec) -196 939 -231 847 -187 856 0.103 Sokolow-Lyon voltage (mm) -4.4 7.4 -4.3 7.3 -3.6 7.3 <0.001 SBP, systolic blood pressure. Powered by Infomedica 26th European Meeting on Hypertension and Cardiovascular Protection
26th European Meeting on Hypertension and Cardiovascular Protection Paris (France), June 10-13, 2016 Change in eGFR by SBP Group SBP 130 mmHg (n=446) SBP 131-141 mmHg (n=2483) SBP 142 mmHg (n=5849) Change in eGFR (ml/min/1.73 m2) Multivariate p value* Univariate p value Baseline to Year-1 0.973 -5.1 10.3 -5.4 11.4 -5.5 11.7 0.851 Baseline to Year-2 0.003 -6.7 10.9 -7.5 10.8 -8.6 10.5 <0.001 Baseline to Year-3 0.039 -7.0 10.4 -7.9 10.6 -8.8 10.7 <0.001 Baseline to Year-4 0.001 -6.3 10.3 -7.9 11.1 -9.2 10.6 <0.001 *Adjusted for age, sex, race, randomized treatment, prior antihypertensive treatment, history of diabetes, MI, ischemic heart disease, heart failure, smoking, baseline serum glucose, total and HDL cholesterol, urine albumin/creatinine ratio, baseline and change in Cornell product and Sokolow-Lyon voltage between baseline and each year. eGFR, estimated glomerular filtration rate; SBP, systolic blood pressure. Powered by Infomedica 26th European Meeting on Hypertension and Cardiovascular Protection
26th European Meeting on Hypertension and Cardiovascular Protection Paris (France), June 10-13, 2016 Overview A consistently smaller change in eGFR was observed in the lower SBP group at each annual evaluation, after adjustment for other risk factors, and a stepwise increase in change in eGFR was observed in the intermediate and higher SBP groups. On-treatment SBP 130 mmHg slowed the rate of reduced eGFR over the 4-year study Lower SBP goals in patients with hypertension and ECG-LVH may slow the progression of hypertension-related renal dysfunction, randomized study needed for confirmation Powered by Infomedica 26th European Meeting on Hypertension and Cardiovascular Protection
26th European Meeting on Hypertension and Cardiovascular Protection Paris (France), June 10-13, 2016 LIFE Study: Lower Systolic Pressure Slowed Progression of Renal Dysfunction in Hypertension From ESH 2016 | POS 4C: Sverre E. Kjeldsen, MD Oslo University Hospital, Ullevaal, Oslo, Norway Infomedica Conference Coverage* of 26th European Meeting on Hypertension and Cardiovascular Protection Paris (France), June 10-13, 2016 * Infomedica is an independent medical education provider that produces medical information to healthcare professionals through conference coverage and online educational programs and activities. Powered by Infomedica
