Intensive BP Control and eGFR Declines: Are These Events Due to Hemodynamic Effects and Are Changes Reversible?
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HYPERTENSION (DS GELLER AND DL COHEN, SECTION EDITORS)
Intensive BP Control and eGFR Declines: Are These Events Due to Hemodynamic Effects and Are Changes Reversible? Debbie C. Chen 1
&
Wendy McCallum 2 & Mark J. Sarnak 2 & Elaine Ku 1,3,4
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Acute declines in estimated glomerular filtration rate (eGFR) are often observed during intensive blood pressure (BP) lowering. This review focuses on identifying the various mechanisms of eGFR decline associated with intensive BP lowering and evaluates the evidence linking BP control with kidney and cardiovascular (CV) outcomes. Recent Findings In 2017, the American College of Cardiology and the American Heart Association (ACC/AHA) began recommending treatment of all individuals to a BP target of < 130/80 mmHg. Since then, multiple post hoc analyses of BP trials have associated intensive BP lowering with acute declines in kidney function and acute kidney injury; whether these represent reversible changes in the kidney is still debated. Summary There is ample evidence that intensive BP lowering is associated with declines in eGFR. The clinical implications of these events remain unclear. Individualizing the risks and benefits of intensive BP therapy continues to be warranted. Keywords Hypertension . Intensive blood pressure . Acute kidney injury . Hemodynamic . Angiotensin-converting enzyme inhibitor . Angiotensin receptor blocker
Introduction Hypertension affects approximately 1.1 billion people worldwide and has consistently been the leading risk factor for This article is part of the Topical Collection on Hypertension * Debbie C. Chen [email protected] Wendy McCallum [email protected] Mark J. Sarnak [email protected] Elaine Ku [email protected] 1
Division of Nephrology, Department of Medicine, University of California San Francisco, 533 Parnassus Ave, U404, San Francisco, CA 94143-0532, USA
2
Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA, USA
3
Division of Nephrology, Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
4
Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
preventable deaths [1, 2]. Treatment of hypertension is important for reducing risk of adverse cardiovascular (CV) events, including myocardial infarction, stroke, heart failure, and death. Hypertension guidelines have evolved over time, initially with the Joint National Committee (JNC) 6 and 7 reports recommending a blood pressure (BP) target of < 140/ 90 mmHg and JNC 8 liberating the BP goal to < 150/ 90 mmHg for patients 60 years of age or older (Table 1) [3–5]. In 2017, the American College of Cardiology and the American Heart Association (ACC/AHA) released new guidelines lowering the clinic systolic BP goal to < 130 mmHg for all patients regardless of age [6••]. The most recent changes to hypertension guidelines have been driven mainly by
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