Abstract 4851: Three-year Target Systolic Blood Pressure Less Than 120 mmHg for More Than 65 Aged Hypertension Patients With Chronic Renal Disease
Background: Many studies demonstrate that systolic blood pressure (SBP) ≥140 mm Hg does not provide renal protection in renal disease with hypertension, but SBP≤120 mmHg may be able to slow progress of renal disease. However, target SBP≤150 mmHg in elderly hypertension patients was recommended in Chinese hypertension guideline in 2005.The safety and efficacy of SBP≤120 mmHg in elderly hypertension patients with chronic renal disease is hardly reported.
Methods: In a prospective, controlled open-label studies, the authors have evaluated the safety and efficacy of three-year treatment on progress of renal disease and risk of development of cardiovascular disease in 122 >65 aged hypertension patients with chronic renal disease. Before randomization, all patients have already been treated for one-year with angiotensin converting enzyme inhibitors (ACEI) or angiotensin AT1 receptor blockade(ARBs) and other antihypertensive drugs, but their SBP are above 140 mmHg but less than 150 mmHg. Blood pressure, serum creatinine(Cr) and potassium were monitored every 14 days in the period of follow-up..
Results: By the end of three years, Cr clearance increased from 51±2.0 to 63±3.2 ml/min, p<0.001,in the group of strict control of SBP, By contrast, Cr clearance decreased significantly from 52±1.9 to 42±2.1 ml/min, P<0.01, in the controls. During this time, urine protein excretion decreased from 1.4±0.5 to 0.4±0.4g every 24 hours (P<0.01) in the treatment group, but urine protein excretion decreased slightly (from 1.3±0.4 to 1.2±0.5, P>0.05) in the controls. Nine patients had got ACS, 10 patients stroke, three patients died in SCD and 2 patients died in chronic heart failure in controls but one patient had ACS, two patients stroke, one died in non-cardiac cause and 2 patients had mild dizzy who can continue to take theses drugs in the treatment group(p<0.01).However, the incidence of hyperkalaemia was similar between two groups.
Conclusions: Long-term SBP≤120 mmHg is safe and was more apparently in decreasing proteinuria, slowing the progress of renal disease and reducing the risk of development of acute cardiovascular events in elderly hypertensive patients with chronic renal disease.