| Limitations of analyses based on achieved blood pressure: lessons from the African American study of kidney disease and hypertension trial. | |
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MedLine Citation:
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PMID: 21555676 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Blood pressure (BP) guidelines that set target BP levels often rely on analyses of achieved BP from hypertension treatment trials. The objective of this article was to compare the results of analyses of achieved BP to intention-to-treat analyses on renal disease progression. Participants (n=1094) in the African-American Study of Kidney Disease and Hypertension Trial were randomly assigned to either usual BP goal defined by a mean arterial pressure goal of 102 to 107 mm Hg or lower BP goal defined by a mean arterial pressure goal of ≤92 mm Hg. Median follow-up was 3.7 years. Primary outcomes were rate of decline in measured glomerular filtration rate and a composite of a decrease in glomerular filtration rate by >50% or >25 mL/min per 1.73 m(2), requirement for dialysis, transplantation, or death. Intention-to-treat analyses showed no evidence of a BP effect on either the rate of decline in glomerular filtration rate or the clinical composite outcome. In contrast, the achieved BP analyses showed that each 10-mm Hg increment in mean follow-up achieved mean arterial pressure was associated with a 0.35 mL/min per 1.73 m(2) (95% CI: 0.08 to 0.62 mL/min per 1.73 m(2); P=0.01) faster mean glomerular filtration rate decline and a 17% (95% CI: 5% to 32%; P=0.006) increased risk of the clinical composite outcome. Analyses based on achieved BP lead to markedly different inferences than traditional intention-to-treat analyses, attributed in part to confounding of achieved BP with comorbidities, disease severity, and adherence. Clinicians and policy makers should exercise caution when making treatment recommendations based on analyses relating outcomes to achieved BP. |
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Authors:
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Esa M Davis; Lawrence J Appel; Xuelei Wang; Tom Greene; Brad C Astor; Mahboob Rahman; Robert Toto; Michael S Lipkowitz; Velvie A Pogue; Jackson T Wright; |
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Publication Detail:
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Type: Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural Date: 2011-05-09 |
Journal Detail:
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Title: Hypertension Volume: 57 ISSN: 1524-4563 ISO Abbreviation: Hypertension Publication Date: 2011 Jun |
Date Detail:
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Created Date: 2011-05-19 Completed Date: 2011-07-22 Revised Date: 2011-09-26 |
Medline Journal Info:
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Nlm Unique ID: 7906255 Medline TA: Hypertension Country: United States |
Other Details:
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Languages: eng Pagination: 1061-8 Citation Subset: IM |
Affiliation:
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Department of Medicine and Center for Research on Health Care, University of Pittsburgh, School of Medicine, 230 McKee Place, Suite 600, Pittsburgh, PA 15213, USA. davisem@upmc.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult African Americans / statistics & numerical data Aged Amlodipine / therapeutic use Antihypertensive Agents / therapeutic use* Blood Pressure / drug effects* Female Follow-Up Studies Glomerular Filtration Rate Humans Hypertension / complications, drug therapy*, physiopathology Kidney Diseases / complications, physiopathology* Male Metoprolol / therapeutic use Middle Aged Proportional Hazards Models Ramipril / therapeutic use Time Factors Treatment Outcome |
| Grant Support | |
ID/Acronym/Agency:
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2P20 RR11104/RR/NCRR NIH HHS; 5M01 RR-00071/RR/NCRR NIH HHS; DK 2818-02/DK/NIDDK NIH HHS; M01 00032//PHS HHS; M01 RR00052/RR/NCRR NIH HHS; M01 RR00827/RR/NCRR NIH HHS; P20-RR11145/RR/NCRR NIH HHS; U01 DK045381-09/DK/NIDDK NIH HHS; U01 DK045386-11/DK/NIDDK NIH HHS; UL1 RR024989/RR/NCRR NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Antihypertensive Agents; 37350-58-6/Metoprolol; 87333-19-5/Ramipril; 88150-42-9/Amlodipine |
| Comments/Corrections | |
Comment In:
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Hypertension. 2011 Jun;57(6):1039-40
[PMID:
21555679
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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