Seven-year target systolic blood pressure less than 120 mmHg for more than 65 aged hypertension patients with chronic renal disease

Abstract

Background: Many studies demonstrate that systolic blood pressure (SBP) ≥140 mm Hg does not provide renal protection in renal disease with hypertension, but SBP ≤120 mmHg may be able to slow progress of renal disease. However, target SBP ≤150 mmHg in elderly hypertension patients was recommended in Chinese hypertension guideline in 2005.The long‐term safety and efficacy of SBP ≤120 mmHg in elderly hypertension patients with chronic renal disease is hardly reported. Methods: In a prospective, controlled open‐label studies, the authors have evaluated the safety and efficacy of ten‐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. BP, 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 blood pressure every day at home and adjusted their own medication according to pre‐agreed rules. Results: By the end of ten year,medication possession ratio between two groups was similar (94% vs 94%), BP in treatment group was 118/68±6/3 mmHg and in control was 149/74±13/9 mmHg, Cr clearance increased from 51±2.0 to 65±3.2 ml/min (p<0.001)in the group of strict control of SBP,by contrast, Cr clearance decreased significantly from 52±1.9 to 30±2.8 ml/min (P<0.01)in the controls. During this time, urine protein excretion decreased from 1.4±0.5 to 0.2±0.2g/24 hours (P<0.0001) in the treatment group, but urine protein excretion decreased slightly (from 1.3±0.4 to 1.1±0.9g, P>0.05)in the controls. Fourteen patients had got ACS, 24 patients stroke, 14 patients renal dialysis (4 patients progress to V stage from III and 10 from IV stage) and fifteen patient died (7 in SCD and 6 in heart failure and 2 in non‐cardiac cause) in controls, and five patients had got ACS, nine patient had stroke, 2 patient renal dialysis (from IV stage) and seven patients died (1 in heart failure and 6 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 in elderly hypertensive patients with chronic renal disease and macroproteinuria.