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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Bibliographic Details
Published in:Current cardiology reports Vol. 22; no. 10; p. 117
Main Authors: Chen, Debbie C., McCallum, Wendy, Sarnak, Mark J., Ku, Elaine
Format: Journal Article
Language:English
Published: New York Springer US 09.08.2020
Subjects:
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
Online Access:Get full text
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Summary: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.
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ISSN:1523-3782
1534-3170
1534-3170
DOI:10.1007/s11886-020-01365-3