Low Achieved Systolic Blood Pressure Related to Kidney Protection in Diabetic and Non-Diabetic High-Risk Hypertensive Patients

TY - JOUR

T1 - Low Achieved Systolic Blood Pressure Related to Kidney Protection in Diabetic and Non-Diabetic High-Risk Hypertensive Patients

AU - Olsen, Eirik

AU - Søraas, Camilla L.

AU - Schmieder, Roland E.

AU - Jamerson, Kenneth

AU - Macdonald, Thomas M.

AU - Mancia, Giuseppe

AU - Heimark, Sondre

AU - Mehlum, Maria H.

AU - Liestøl, Knut

AU - Larstorp, Anne C.K.

AU - Mariampillai, Julian E.

AU - Mo, Rune

AU - Halvorsen, Lene V.

AU - Høieggen, Aud

AU - Rostrup, Morten

AU - Kjeldsen, Sverre E.

AU - Weber, Michael A.

N1 - Publisher Copyright: © 2025 The Author(s). Published by Oxford University Press on behalf of American Journal of Hypertension, Ltd.

PY - 2025/12/1

Y1 - 2025/12/1

N2 - BACKGROUND Protecting the kidneys by lowering systolic blood pressure (SBP) in hypertensive patients is not unequivocally settled. We tested the hypothesis that achieving lower average SBP in middle-aged and older high-risk hypertensive patients with and without type-2 diabetes mellitus through several years would clarify kidney protection. METHODS We analyzed patients 50-80 years with no cardiovascular events during the first 6 months of drug up-titration after randomization to valsartan or amlodipine, and with 3 or more visits onwards with standardized BP measurements. Adjusted Cox analyzes compared worsened kidney function defined as a 50% rise in se-creatinine on a minimum of two occasions at least 4 weeks apart or end-stage kidney disease (ESKD) in achieved SBP quartiles and in patients who achieved SBP < 130 and 130-139 mmHg with patients whose SBP remained ≥140 mmHg. RESULTS A total of 13,803 patients were investigated of whom 4,655 had DM. Patients with DM had less worsened kidney function at SBP 130-139 mmHg (HR = 0.524, 95% CIs 0.375-0.733, n = 1849, P < 0.001) and at SBP < 130 mmHg (HR = 0.538, CIs 0.316-0.915, n = -674, P = 0.022) compared with patients at ≥ 140 mmHg. They also had less ESKD at SBP 130-139 mmHg (HR = 0.442, CIs 0.196-1.000, P = 0.050) with a similar trend at SBP < 130 mmHg and in quartile analysis with only 1 ESKD in the lowest quartile. Findings in patients without DM (n = 9,148) were similar to DM. CONCLUSIONS In high-risk hypertensive patients aged 50-80 years, with and without DM, targeting SBP of 130-139 mmHg confers kidney protection with possible further benefit at the lower target of SBP < 130 mmHg. Clinical trials registration Trial Number NCT06395194, www.clinicaltrials.gov.

AB - BACKGROUND Protecting the kidneys by lowering systolic blood pressure (SBP) in hypertensive patients is not unequivocally settled. We tested the hypothesis that achieving lower average SBP in middle-aged and older high-risk hypertensive patients with and without type-2 diabetes mellitus through several years would clarify kidney protection. METHODS We analyzed patients 50-80 years with no cardiovascular events during the first 6 months of drug up-titration after randomization to valsartan or amlodipine, and with 3 or more visits onwards with standardized BP measurements. Adjusted Cox analyzes compared worsened kidney function defined as a 50% rise in se-creatinine on a minimum of two occasions at least 4 weeks apart or end-stage kidney disease (ESKD) in achieved SBP quartiles and in patients who achieved SBP < 130 and 130-139 mmHg with patients whose SBP remained ≥140 mmHg. RESULTS A total of 13,803 patients were investigated of whom 4,655 had DM. Patients with DM had less worsened kidney function at SBP 130-139 mmHg (HR = 0.524, 95% CIs 0.375-0.733, n = 1849, P < 0.001) and at SBP < 130 mmHg (HR = 0.538, CIs 0.316-0.915, n = -674, P = 0.022) compared with patients at ≥ 140 mmHg. They also had less ESKD at SBP 130-139 mmHg (HR = 0.442, CIs 0.196-1.000, P = 0.050) with a similar trend at SBP < 130 mmHg and in quartile analysis with only 1 ESKD in the lowest quartile. Findings in patients without DM (n = 9,148) were similar to DM. CONCLUSIONS In high-risk hypertensive patients aged 50-80 years, with and without DM, targeting SBP of 130-139 mmHg confers kidney protection with possible further benefit at the lower target of SBP < 130 mmHg. Clinical trials registration Trial Number NCT06395194, www.clinicaltrials.gov.

KW - blood pressure

KW - chronic kidney disease

KW - creatinine

KW - end-stage kidney disease

KW - hypertension

KW - kidney function

KW - the VALUE Trial

UR - https://www.scopus.com/pages/publications/105021880801

U2 - 10.1093/ajh/hpaf093

DO - 10.1093/ajh/hpaf093

M3 - Article

C2 - 40397037

AN - SCOPUS:105021880801

SN - 0895-7061

VL - 38

SP - 1106

EP - 1119

JO - American Journal of Hypertension

JF - American Journal of Hypertension

IS - 12

ER -