ACHIEVEMENT AND SAFETY OF A LOW BLOOD-PRESSURE GOAL IN CHRONIC RENAL-DISEASE - THE MODIFICATION OF DIET IN RENAL-DISEASE STUDY-GROUP

The Modification of Diet in Renal Disease Study showed a beneficial ef fect of a lower-than-usual blood pressure (BP) goal on the progression of renal disease in patients with proteinuria. The purpose of the pre sent analyses was to examine the achieved BP, baseline characteristics that helped or hindered achievement of the BP goals, and safety of th e BP interventions. Five hundred eighty-five patients with baseline gl omerular filtration rate between 13 and 55 mL/min per 1.73 m(2) (0.22 to 0.92 mL/s per 1.73 m(2)) were randomly assigned to either a usual o r low BP goal (mean arterial pressure less than or equal to 107 or les s than or equal to 92 mm Hg, respectively). Few patients had a history of cardiovascular disease. All antihypertensive agents were permitted , but angiotensin-converting enzyme inhibitors (with or without diuret ics) followed by calcium channel blockers were preferred. The mean (+/ -SD) of the mean arterial pressures during follow-up in the low and us ual BP groups was 93.0+/-7.3 and 97.7+/-7.7 mm Hg, respectively. Follo w-up BP was significantly higher in subgroups of patients with preexis ting hypertension, baseline mean arterial pressure >92 mm Hg, a diagno sis of polycystic kidney disease or glomerular diseases, baseline urin ary protein excretion >1 g/d, age greater than or equal to 61 years, a nd black race. The frequency of medication changes and incidence of sy mptoms of low BP were greater in the low BP group, but there were no s ignificant differences between BP groups in stop points, hospitalizati ons, or death. When data from both groups were combined, each 1-mm Hg increase in follow-up systolic BP was associated with a 1.35-times gre ater risk of hospitalization for cardiovascular or cerebrovascular dis ease. Lower BP than usually recommended for the prevention of cardiova scular disease is achievable by several medication regimens mens witho ut serious adverse effects in patients with chronic renal disease with out cardiovascular disease. For patients with urinary protein excretio n >1 g/d, target BP should be a mean arterial pressure of less than or equal to 92 mm Hg, equivalent to 125/75 mm Hg.