On-treatment systolic blood pressure and preserved kidney function in hypertensive patients with proteinuria. The VALUE Trial

Aims: We investigated on-treatment systolic BP (SBP) <130, 130–139 and ≥140 mmHg related to nephroprotection in 3065 patients with proteinuria and 10,738 patients without proteinuria in the VALUE Trial. Method and results: Worsened kidney function (WKF) was ≥50% increase in serum creatinine, and end-stage kidney disease (ESKD) was dialysis/transplantation. Cox proportional hazards models were adjusted for covariates in the on-treatment SBP groups. Lower SBP was significantly related to less WKF (p <.001) in patients with proteinuria, both at <130 mmHg (n = 14/529, 2.6%) and 130–139 mmHg (n = 46/1176, 3.9%) compared to ≥140 mmHg (n = 145/1358, 10.7%). None of the 532 patients with proteinuria had ESKD at <130 mmHg, and only 11/1194 (0.9%) at 130–139 mmHg (p =.098) compared to 39/1339 (2.9%) at SBP ≥ 140 mmHg. In patients without proteinuria the relation between lower SBP and WKF was not significant (p =.23) at <130 mmHg (n = 24/1927, 1.2%) but significant (p =.04) at 130–139 mmHg (n = 74/4611, 1.6%) compared to SBP ≥ 140 mmHg (n = 117/4199, 2.8%). ESKD was 0.2%, 0.2% and 0.4% in the SBP groups, respectively. WKF fell from 12.1% in Q1 (highest SBP quartile) to 6.1% in Q2 (p =.023), 4.2% in Q3 (p =.006) and 2.8% in Q4 (p <.001) in patients with proteinuria and ESKD from 3.5% (Q1) to 1.6% (Q2) (p =.13), 0.7% (Q3) (p =.027) and 0.1% in Q4 (p =.009). In the patients without proteinuria, neither WKF nor ESKD showed statistically significant changes between SBP quartiles. Conclusions: Our data suggest that, compared to SBP ≥ 140 mmHg, on-treatment SBP <130 and 130–139 mmHg were strongly related to nephroprotection in hypertensive patients with proteinuria.