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Determinants of Progression in Early Autosomal Dominant Polycystic Kidney Disease: Is it Blood Pressure or Renin-Angiotensin-Aldosterone- System Blockade?
- Source :
- Current Hypertension Reviews. 14:39-47
- Publication Year :
- 2018
- Publisher :
- Bentham Science Publishers Ltd., 2018.
-
Abstract
- Background The HALT PKD trial in early autosomal dominant polycystic kidney disease (ADPKD) showed that intensive control of systolic blood pressure to 95-110 mmHg was associated with a 14% slower rate of kidney volume growth compared to standard control. It is unclear whether this result was due to greater blockade of the renin-angiotensin-aldosterone system (RAAS) by allowing the use of higher drug doses in the low blood pressure arm, or due to the lower blood pressure per se. Methods In this secondary analysis of HALT PKD Study A, we categorized participants into high and low dose groups based on the median daily equivalent dose of RAAS blocking drugs used after the initial dose titration period. Using linear mixed models, we compared the percent change in total kidney volume and the slope of estimated glomerular filtration rate (eGFR) between the 2 groups. We also assessed the effects of time-varying dose and time-varying blood pressure parameters on these outcomes. Results Subjects in the high dose group (n=252) did not experience a slower increase in total kidney volume than those in the low-dose (n=225) group, after adjustment for age, sex, genotype, and BP arm. The chronic slope of eGFR decline was similar in the 2 groups. Higher time-varying systolic blood pressure was associated with a steeper decline in eGFR. Conclusion ADPKD progression (as detected by eGFR decline and TKV increase) was ameliorated by intense blood pressure control as opposed to pharmacologic intensity of RAAS blockade.
- Subjects :
- Adult
Male
Drug doses
medicine.medical_specialty
Time Factors
Adolescent
030232 urology & nephrology
Urology
Autosomal dominant polycystic kidney disease
Renal function
Angiotensin-Converting Enzyme Inhibitors
Blood Pressure
Kidney Volume
030204 cardiovascular system & hematology
Kidney
Article
Renin-Angiotensin System
Angiotensin Receptor Antagonists
Young Adult
03 medical and health sciences
0302 clinical medicine
Renin–angiotensin system
Internal Medicine
Humans
Medicine
Antihypertensive Agents
Randomized Controlled Trials as Topic
business.industry
Middle Aged
Polycystic Kidney, Autosomal Dominant
medicine.disease
3. Good health
Blockade
Intensity (physics)
Treatment Outcome
Blood pressure
Hypertension
Disease Progression
Female
business
Glomerular Filtration Rate
Subjects
Details
- ISSN :
- 15734021
- Volume :
- 14
- Database :
- OpenAIRE
- Journal :
- Current Hypertension Reviews
- Accession number :
- edsair.doi.dedup.....c7a80e17513f953393d798132d91f746