Intensive BP Control and eGFR Declines: Are These Events Due to Hemodynamic Effects and Are Changes Reversible?

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 cont...

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Vydáno v:	Current cardiology reports Ročník 22; číslo 10; s. 117
Hlavní autoři:	Chen, Debbie C., McCallum, Wendy, Sarnak, Mark J., Ku, Elaine
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	New York Springer US 09.08.2020
Témata:	American Heart Association Antihypertensive Agents - pharmacology Antihypertensive Agents - therapeutic use Blood Pressure Cardiology Glomerular Filtration Rate Humans Hypertension (DS Geller and DL Cohen Hypertension - drug therapy Medicine Medicine & Public Health Section Editors Topical Collection on Hypertension United States United States Hypertension Angiotensin-converting enzyme inhibitor Intensive blood pressure Angiotensin receptor blocker Acute kidney injury Hemodynamic
ISSN:	1523-3782, 1534-3170, 1534-3170
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Shrnutí:	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.
Bibliografie:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 ObjectType-Review-3 content type line 23
ISSN:	1523-3782 1534-3170 1534-3170
DOI:	10.1007/s11886-020-01365-3