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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Vydané v:	Current cardiology reports Ročník 22; číslo 10; s. 117
Hlavní autori:	Chen, Debbie C., McCallum, Wendy, Sarnak, Mark J., Ku, Elaine
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	New York Springer US 09.08.2020
Predmet:	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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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.
AbstractList	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. 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. 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. 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. 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.PURPOSE OF REVIEWAcute 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.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. 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.RECENT FINDINGSIn 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. 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.
ArticleNumber	117
Author	Sarnak, Mark J. McCallum, Wendy Chen, Debbie C. Ku, Elaine
AuthorAffiliation	1 Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, CA 4 Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 2 Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA 3 Division of Nephrology, Department of Pediatrics, University of California San Francisco, San Francisco, CA
AuthorAffiliation_xml	– name: 1 Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, CA – name: 2 Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA – name: 4 Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA – name: 3 Division of Nephrology, Department of Pediatrics, University of California San Francisco, San Francisco, CA
Author_xml	– sequence: 1 givenname: Debbie C. orcidid: 0000-0002-1043-174X surname: Chen fullname: Chen, Debbie C. email: debbie.chen@ucsf.edu organization: Division of Nephrology, Department of Medicine, University of California San Francisco – sequence: 2 givenname: Wendy surname: McCallum fullname: McCallum, Wendy organization: Division of Nephrology, Department of Medicine, Tufts Medical Center – sequence: 3 givenname: Mark J. surname: Sarnak fullname: Sarnak, Mark J. organization: Division of Nephrology, Department of Medicine, Tufts Medical Center – sequence: 4 givenname: Elaine surname: Ku fullname: Ku, Elaine organization: Division of Nephrology, Department of Medicine, University of California San Francisco, Division of Nephrology, Department of Pediatrics, University of California San Francisco, Department of Epidemiology and Biostatistics, University of California San Francisco
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KuEIxJHJamersonKTangriNLinFGassmanJSmogorzewskiMSarnakMJAcute declines in renal function during intensive BP lowering and long-term risk of deathJ Am Soc Nephrol20182992401240810.1681/asn.2018040365300064176115661 WaldRQuinnRRLuoJLiPScalesDCMamdaniMMRayJGUniversity of Toronto Acute Kidney Injury Research GroupChronic dialysis and death among survivors of acute kidney injury requiring dialysisJAMA.200930211117911851:CAS:528:DC%2BD1MXhtFCitb3J10.1001/jama.2009.132219755696 SchmittRCocaSKanbayMTinettiMECantleyLGParikhCRRecovery of kidney function after acute kidney injury in the elderly: a systematic review and meta-analysisAm J Kidney Dis200852226227110.1053/j.ajkd.2008.03.00518511164 InkerLASchmidCHTighiouartHEckfeldtJHFeldmanHIGreeneTKusekJWManziJvan LenteFZhangYLCoreshJLeveyASCKD-EPI InvestigatorsEstimating glomerular filtration rate from serum creatinine and cystatin CN Engl J Med2012367120291:CAS:528:DC%2BC38XhtVOqs7bN10.1056/NEJMoa1114248227623154398023 KuELeeBJWeiJWeirMRHypertension in CKD: core curriculum 2019Am J Kidney Dis201974112013110.1053/j.ajkd.2018.12.04430898362 WrightJTJrBakrisGGreeneTAgodoaLYAppelLJCharlestonJEffect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease: results from the AASK trialJama.200228819242124311:CAS:528:DC%2BD38XoslOktr8%3D10.1001/jama.288.19.242112435255 HirschSPre-renal successKidney Int201281659610.1038/ki.2011.41822373705author reply 7 BrennerBMCooperMEde ZeeuwDKeaneWFMitchWEParvingHHRemuzziGSnapinnSMZhangZShahinfarSRENAAL Study InvestigatorsEffects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathyN Engl J Med2001345128618691:CAS:528:DC%2BD3MXntlelsLk%3D10.1056/NEJMoa01116111565518 HsuCYChertowGMMcCullochCEFanDOrdonezJDGoASNonrecovery of kidney function and death after acute on chronic renal failureClin J Am Soc Nephrol20094589189810.2215/cjn.05571008194069592676192 BeddhuSGreeneTBoucherRCushmanWCWeiGStoddardGIxJHChoncholMKramerHCheungAKKimmelPLWheltonPKChertowGMIntensive systolic blood pressure control and incident chronic kidney disease in people with and without diabetes mellitus: secondary analyses of two randomised controlled trialsLancet Diabetes Endocrinol20186755556310.1016/s2213-8587(18)30099-8296858606071316 BeddhuSRoccoMVTotoRCravenTEGreeneTBhattUEffects of intensive systolic blood pressure control on kidney and cardiovascular outcomes in persons without kidney disease: a secondary ana PK Whelton (1365_CR6) 2018; 138 M Schmidt (1365_CR33) 2017; 356 JD Williamson (1365_CR53) 2016; 315 M Carlstrom (1365_CR13) 2015; 95 S Anderson (1365_CR46) 2011; 22 BF Palmer (1365_CR10) 2002; 347 AJ Apperloo (1365_CR29) 1997; 51 MV Rocco (1365_CR43) 2018; 71 R Wald (1365_CR48) 2009; 302 R Malhotra (1365_CR16) 2019; 73 E Ku (1365_CR25) 2018; 29 Y Obi (1365_CR55) 2018; 283 CA Peralta (1365_CR15) 2016; 133 R Schmitt (1365_CR50) 2008; 52 S Yusuf (1365_CR37) 2008; 358 CM Clase (1365_CR35) 2017; 91 JT Wright Jr (1365_CR7) 2015; 373 LA Inker (1365_CR27) 2012; 367 AV Chobanian (1365_CR4) 2003; 289 E Ku (1365_CR24) 2017; 28 E Ku (1365_CR26) 2019; 74 T Ohkuma (1365_CR34) 2019; 73 S Beddhu (1365_CR8) 2017; 167 BM Brenner (1365_CR36) 2001; 345 S Hirsch (1365_CR32) 2012; 36 AK Cheung (1365_CR57) 2017; 28 CY Hsu (1365_CR47) 2009; 4 A Ishani (1365_CR49) 2009; 20 AD Rule (1365_CR58) 2004; 43 S Beddhu (1365_CR20) 2019; 30 1365_CR12 G Fuiano (1365_CR51) 2001; 59 PA James (1365_CR5) 2014; 311 OR Benavente (1365_CR14) 2013; 382 NM Pajewski (1365_CR54) 2020; 68 JM Testani (1365_CR31) 2011; 4 JT Wright Jr (1365_CR21) 2002; 288 GL Bakris (1365_CR28) 2000; 160 AK Cheung (1365_CR52) 2019; 95 FA Holtkamp (1365_CR11) 2011; 80 WR Zhang (1365_CR17) 2018; 169 S Hirsch (1365_CR30) 2012; 81 S Yusuf (1365_CR38) 2008; 372 MA Venkatachalam (1365_CR42) 2015; 26 S Beddhu (1365_CR59) 2018; 6 S Klahr (1365_CR22) 1994; 330 A Patel (1365_CR39) 2008; 358 AP Bress (1365_CR44) 2017; 135 WC Cushman (1365_CR18) 2010; 362 DH Kang (1365_CR56) 2002; 13 F Barrantes (1365_CR45) 2009; 84 GN Nadkarni (1365_CR19) 2019; 73 E Ku (1365_CR23) 2019; 8 1365_CR1 1365_CR2 1365_CR3 W McCallum (1365_CR40) 2020; 75 W McCallum (1365_CR41) 2019; 96 1365_CR9
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Snippet	Purpose of Review Acute declines in estimated glomerular filtration rate (eGFR) are often observed during intensive blood pressure (BP) lowering. This review... Acute declines in estimated glomerular filtration rate (eGFR) are often observed during intensive blood pressure (BP) lowering. This review focuses on...
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SubjectTerms	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
Title	Intensive BP Control and eGFR Declines: Are These Events Due to Hemodynamic Effects and Are Changes Reversible?
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