Information de reference pour ce titreAccession Number: | 00000605-200503010-00009.
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Author: | Sarnak, Mark J. MD; Greene, Tom PhD; Wang, Xuelei MS; Beck, Gerald PhD; Kusek, John W. PhD; Collins, Allan J. MD; Levey, Andrew S. MD
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Institution: | From Tufts-New England Medical Center, Boston, Massachusetts; Cleveland Clinic Foundation, Cleveland, Ohio; National Institute of Health, Bethesda, Maryland; and U.S. Renal Data System, Minneapolis, Minnesota.
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Title: | |
Source: | Annals of Internal Medicine. 142(5):342-351, March 1, 2005.
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Abstract: | Background: Hypertension is a risk factor for progression of chronic kidney disease. The optimal blood pressure to slow progression is unknown.
Objective: To evaluate the effects of a low target blood pressure on kidney failure and all-cause mortality.
Design: Long-term follow-up of the Modification of Diet in Renal Disease Study, a randomized, controlled trial conducted from 1989 to 1993.
Setting: 15 outpatient nephrology practices.
Participants: 840 persons with predominantly nondiabetic kidney disease and a glomerular filtration rate of 13 to 55 mL/min per 1.73 m2.
Intervention: A low target blood pressure (mean arterial pressure < 92 mm Hg) or a usual target blood pressure (mean arterial pressure < 107 mm Hg).
Measurements: After the randomized trial was completed, kidney failure (defined as initiation of dialysis or kidney transplantation) and a composite outcome of kidney failure or all-cause mortality were ascertained through 31 December 2000.
Results: Kidney failure occurred in 554 participants (66%), and the composite outcome occurred in 624 participants (74%). After Cox proportional hazards modeling and intention-to-treat analysis, the adjusted hazard ratios were 0.68 (95% CI, 0.57 to 0.82; P < 0.001) for kidney failure and 0.77 (CI, 0.65 to 0.91; P = 0.0024) for the composite outcome in the low target blood pressure group compared with the usual target blood pressure group. Evidence was insufficient to conclude that the benefit of a low target blood pressure differed according to the cause of kidney disease, baseline glomerular filtration rate, or degree of proteinuria.
Limitations: The exact mechanism underlying the benefit of a low target blood pressure is unknown.
Conclusions: Assignment to a low target blood pressure slowed the progression of nondiabetic kidney disease in patients with a moderately to severely decreased glomerular filtration rate.
(C) 2005 American College of Physicians
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References: | 1. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289:2560-72. [PMID: 12748199]
2. K/DOQI clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease. Am J Kidney Dis. 2004;43:S1-290. [PMID: 15114537].
3. Klahr S, Levey AS, Beck GJ, Caggiula AW, Hunsicker L, Kusek JW, et al. The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal disease. Modification of Diet in Renal Disease Study Group. N Engl J Med. 1994;330:877-84. [PMID: 8114857]
4. Wright JT Jr, Bakris G, Greene T, Agodoa LY, Appel LJ, Charleston J, et al. Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease: results from the AASK trial. JAMA. 2002;288:2421-31. [PMID: 12435255]
5. Klahr S. The modification of diet in renal disease study. N Engl J Med. 1989;320:864-6. [PMID: 2494456]
6. Beck GJ, Berg RL, Coggins CH, Gassman JJ, Hunsicker LG, Schluchter MD, et al. Design and statistical issues of the Modification of Diet in Renal Disease Trial. The Modification of Diet in Renal Disease Study Group. Control Clin Trials. 1991;12:566-86. [PMID: 1664792]
7. Peterson JC, Adler S, Burkart JM, Greene T, Hebert LA, Hunsicker LG, et al. Blood pressure control, proteinuria, and the progression of renal disease. The Modification of Diet in Renal Disease Study. Ann Intern Med. 1995;123:754-62. [PMID: 7574193]
8. Hunsicker LG, Adler S, Caggiula A, England BK, Greene T, Kusek JW, et al. Predictors of progression of renal disease in the Modification of Diet in Renal Disease Study. Kidney Int. 1997;51:1908-19. [PMID: 9186882]
9. Jafar TH, Schmid CH, Landa M, Giatras I, Toto R, Remuzzi G, et al. Angiotensin-converting enzyme inhibitors and progression of nondiabetic renal disease. A meta-analysis of patient-level data. Ann Intern Med. 2001;135:73-87. [PMID: 11453706]
10. Jafar TH, Stark PC, Schmid CH, Landa M, Maschio G, de Jong PE, et al. Progression of chronic kidney disease: the role of blood pressure control, proteinuria, and angiotensin-converting enzyme inhibition: a patient-level meta-analysis. Ann Intern Med. 2003;139:244-52. [PMID: 12965979]
11. Klahr S, Breyer JA, Beck GJ, Dennis VW, Hartman JA, Roth D, et al. Dietary protein restriction, blood pressure control, and the progression of polycystic kidney disease. Modification of Diet in Renal Disease Study Group. J Am Soc Nephrol. 1995;5:2037-47. [PMID: 7579052]
12. Appel LJ, Middleton J, Miller ER 3rd, Lipkowitz M, Norris K, Agodoa LY, et al. The rationale and design of the AASK cohort study. J Am Soc Nephrol. 2003;14:S166-72. [PMID: 12819323]
13. Lewis EJ, Hunsicker LG, Bain RP, Rohde RD. The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy. The Collaborative Study Group. N Engl J Med. 1993;329:1456-62. [PMID: 8413456]
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Language: | English.
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Document Type: | Article.
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Journal Subset: | Clinical Medicine.
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ISSN: | 0003-4819
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NLM Journal Code: | 0372351, 5a6
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