Reconciling Systolic Blood Pressure Intervention Trial With Eighth Joint National Commission

A Nuanced View of Optimal Hypertension Control in the Chronic Kidney Disease Population

Ekamol Tantisattamo; Anum Hamiduzzaman; Peter Sohn; Rebecca Ahdoot; Ramy M. Hanna


Curr Opin Nephrol Hypertens. 2022;31(1):57-62. 

In This Article

Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients Trial

The strategy of blood pressure intervention in the elderly hypertensive patients (STEP) trial sought to specifically duplicate the findings of the SPRINT in elderly populations and 20% had diabetes. The trial performed mostly in mainland China enrolled nearly 9,600 patients between an intensive BP treatment group (110–130mmHg) and a standard BP group (<140 Hg).[20] The findings duplicated the improved cardiovascular and cerebrovascular event reduction of the SPRINT, finding a lower risk of MI, unstable angina, Congestive heart failure, coronary artery disease, paroxysmal atrial fibrillation, or cardiovascular death but with no discernible difference in safety except for a positive finding of increased risk of hypotension in the treatment arm.[20] There was no significant difference in the proportion of eGFR decline between 2 groups in both with and without baseline CKD. Although discordant with SPRINT in its relative safety outcomes, it appears that the hypotension signal cannot be ignored and that the BP range of 110–130 mmHg may have changed the expected outcome[20] vis a vie the SPRINT treatment arm of <120mmHg. Moreover, only 2% of the study population had baseline eGFR < 60 ml/min/1.73 m2, and this small proportion of CKD is unlikely to be apparent in the older population. Therefore, intensive BP control from STEP trial in the elderly population should be implemented with caution and more BP studies in elderly CKD patients may be required.