Abstract 8903: Six-year Target Systolic Blood Pressure Less Than 120 mmHg For More Than 65 Aged Hypertension Patients With Chronic Renal Disease
Background: Three year target SBP≦120 mmHg in elderly hypertension patients with chronic kidney disease(CKD) was safety and efficacy was reported in 2009 AHA meeting by us.The six year safety and efficacy of SBP≦120 mmHg in these patient is not reported.
Methods: In a prospective, controlled open-label studies, the authors have evaluated the safety and efficacy of six-year treatment on progress of renal disease and risk of development of cardiovascular disease in 122 >65 aged hypertension patients with chronic renal disease III to IV stage and macroproteinuria. 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,less than 150 mmHg. Blood pressure , serum creatinine(Cr) and potassium were monitored every 14 days in the period of follow-up by physician and healthcare nurse and more frequent patient-physician encounters will be improve that patients monitored their BP every day at home and adjusted their own medication according to pre-agreed rules.
Results: By the end of six year,medication possession ratio between two groups was similar(94% vs 94%), mean BP in treatment group was 116/66±6/3 mmHg and in control was 146/78±13/9 mmHg, Cr clearance increased from 51±2.0 to 63±3.0 ml/min (p<0.001)in the group of strict control of SBP,by contrast, Cr clearance decreased significantly from 52±1.9 to 34±2.4 ml/min( P<0.01)in the controls. During this time, urine protein excretion decreased from 1.4±0.5 to 0.2±0.4g/24 hours(P0.05)in the controls. Ten patients had got ACS ,17 patients stroke.21 patients had got pneumonia , 10 patients renal dialysis and eight patient died (5 in SCD and 3 in heart failure) in controls, and three patients had got ACS, six patient had stroke ,nine pneumonia, 1 patient renal dialysis and four patients died in non-cardiac causes in the treatment group.Incidence of hyperkalaemia was similar between two groups.
Conclusions: 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 cardiovascular events and pneumonia in elderly hypertensive patients with CKD
- © 2012 by American Heart Association, Inc.