Progression of Chronic Kidney Disease

The Role of Blood Pressure Control, Proteinuria, and Angiotensin-Converting Enzyme Inhibition. A Patient-Level Meta-Analysis

Tazeen H. Jafar, Paul C. Stark, Christopher H. Schmid, Marcia Landa, Giuseppe Maschio, Paul E. De Jong, Dick De Zeeuw, Shahnaz Shahinfar, Robert Toto, Andrew S. Levey

Research output: Contribution to journalArticle

829 Citations (Scopus)

Abstract

Background: Angiotensin-converting enzyme (ACE) inhibitors reduce blood pressure and urine protein excretion and slow the progression of chronic kidney disease. Purpose. To determine the levels of blood pressure and urine protein excretion associated with the lowest risk for progression of chronic kidney disease during antihypertensive therapy with and without ACE inhibitors. Data Sources: 11 randomized, controlled trials comparing the efficacy of antihypertensive regimens with or without ACE inhibitors for patients with predominantly nondiabetic kidney disease. Study Selection. MEDLINE database search for English-language studies published between 1977 and 1999. Data Extraction: Data on 1860 nondiabetic patients were pooled in a patient-level meta-analysis. Progression of kidney disease was defined as a doubling of baseline serum creatinine level or onset of kidney failure. Multivariable regression analysis was performed to assess the association of systolic and diastolic blood pressure and urine protein excretion with kidney disease progression at 22 610 patient visits. Data Synthesis: Mean duration of follow-up was 2.2 years. Kidney disease progression was documented in 311 patients. Systolic blood pressure of 110 to 129 mm Hg and urine protein excretion less than 2.0 g/d were associated with the lowest risk for kidney disease progression. Angiotensin-converting enzyme inhibitors remained beneficial after adjustment for blood pressure and urine protein excretion (relative risk, 0.67 [95% CI, 0.53 to 0.84]). The increased risk for kidney progression at higher systolic blood pressure levels was greater in patients with urine protein excretion greater than 1.0 g/d (P < 0.006). Conclusion: Although reverse causation cannot be excluded with certainty, a systolic blood pressure goal between 110 and 129 mm Hg may be beneficial in patients with urine protein excretion greater than 1.0 g/d. Systolic blood pressure less than 110 mm Hg may be associated with a higher risk for kidney disease progression.

Original languageEnglish (US)
JournalAnnals of Internal Medicine
Volume139
Issue number4
StatePublished - Aug 19 2003

Fingerprint

Peptidyl-Dipeptidase A
Chronic Renal Insufficiency
Proteinuria
Meta-Analysis
Blood Pressure
Kidney Diseases
Urine
Angiotensin-Converting Enzyme Inhibitors
Disease Progression
Proteins
Antihypertensive Agents
Inhibition (Psychology)
Information Storage and Retrieval
MEDLINE
Causality
Renal Insufficiency
Creatinine
Language
Randomized Controlled Trials
Regression Analysis

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Progression of Chronic Kidney Disease : The Role of Blood Pressure Control, Proteinuria, and Angiotensin-Converting Enzyme Inhibition. A Patient-Level Meta-Analysis. / Jafar, Tazeen H.; Stark, Paul C.; Schmid, Christopher H.; Landa, Marcia; Maschio, Giuseppe; De Jong, Paul E.; De Zeeuw, Dick; Shahinfar, Shahnaz; Toto, Robert; Levey, Andrew S.

In: Annals of Internal Medicine, Vol. 139, No. 4, 19.08.2003.

Research output: Contribution to journalArticle

Jafar, TH, Stark, PC, Schmid, CH, Landa, M, Maschio, G, De Jong, PE, De Zeeuw, D, Shahinfar, S, Toto, R & Levey, AS 2003, 'Progression of Chronic Kidney Disease: The Role of Blood Pressure Control, Proteinuria, and Angiotensin-Converting Enzyme Inhibition. A Patient-Level Meta-Analysis', Annals of Internal Medicine, vol. 139, no. 4.
Jafar, Tazeen H. ; Stark, Paul C. ; Schmid, Christopher H. ; Landa, Marcia ; Maschio, Giuseppe ; De Jong, Paul E. ; De Zeeuw, Dick ; Shahinfar, Shahnaz ; Toto, Robert ; Levey, Andrew S. / Progression of Chronic Kidney Disease : The Role of Blood Pressure Control, Proteinuria, and Angiotensin-Converting Enzyme Inhibition. A Patient-Level Meta-Analysis. In: Annals of Internal Medicine. 2003 ; Vol. 139, No. 4.
@article{05a80d5075e444f58ed73ea64a491d86,
title = "Progression of Chronic Kidney Disease: The Role of Blood Pressure Control, Proteinuria, and Angiotensin-Converting Enzyme Inhibition. A Patient-Level Meta-Analysis",
abstract = "Background: Angiotensin-converting enzyme (ACE) inhibitors reduce blood pressure and urine protein excretion and slow the progression of chronic kidney disease. Purpose. To determine the levels of blood pressure and urine protein excretion associated with the lowest risk for progression of chronic kidney disease during antihypertensive therapy with and without ACE inhibitors. Data Sources: 11 randomized, controlled trials comparing the efficacy of antihypertensive regimens with or without ACE inhibitors for patients with predominantly nondiabetic kidney disease. Study Selection. MEDLINE database search for English-language studies published between 1977 and 1999. Data Extraction: Data on 1860 nondiabetic patients were pooled in a patient-level meta-analysis. Progression of kidney disease was defined as a doubling of baseline serum creatinine level or onset of kidney failure. Multivariable regression analysis was performed to assess the association of systolic and diastolic blood pressure and urine protein excretion with kidney disease progression at 22 610 patient visits. Data Synthesis: Mean duration of follow-up was 2.2 years. Kidney disease progression was documented in 311 patients. Systolic blood pressure of 110 to 129 mm Hg and urine protein excretion less than 2.0 g/d were associated with the lowest risk for kidney disease progression. Angiotensin-converting enzyme inhibitors remained beneficial after adjustment for blood pressure and urine protein excretion (relative risk, 0.67 [95{\%} CI, 0.53 to 0.84]). The increased risk for kidney progression at higher systolic blood pressure levels was greater in patients with urine protein excretion greater than 1.0 g/d (P < 0.006). Conclusion: Although reverse causation cannot be excluded with certainty, a systolic blood pressure goal between 110 and 129 mm Hg may be beneficial in patients with urine protein excretion greater than 1.0 g/d. Systolic blood pressure less than 110 mm Hg may be associated with a higher risk for kidney disease progression.",
author = "Jafar, {Tazeen H.} and Stark, {Paul C.} and Schmid, {Christopher H.} and Marcia Landa and Giuseppe Maschio and {De Jong}, {Paul E.} and {De Zeeuw}, Dick and Shahnaz Shahinfar and Robert Toto and Levey, {Andrew S.}",
year = "2003",
month = "8",
day = "19",
language = "English (US)",
volume = "139",
journal = "Annals of Internal Medicine",
issn = "0003-4819",
publisher = "American College of Physicians",
number = "4",

}

TY - JOUR

T1 - Progression of Chronic Kidney Disease

T2 - The Role of Blood Pressure Control, Proteinuria, and Angiotensin-Converting Enzyme Inhibition. A Patient-Level Meta-Analysis

AU - Jafar, Tazeen H.

AU - Stark, Paul C.

AU - Schmid, Christopher H.

AU - Landa, Marcia

AU - Maschio, Giuseppe

AU - De Jong, Paul E.

AU - De Zeeuw, Dick

AU - Shahinfar, Shahnaz

AU - Toto, Robert

AU - Levey, Andrew S.

PY - 2003/8/19

Y1 - 2003/8/19

N2 - Background: Angiotensin-converting enzyme (ACE) inhibitors reduce blood pressure and urine protein excretion and slow the progression of chronic kidney disease. Purpose. To determine the levels of blood pressure and urine protein excretion associated with the lowest risk for progression of chronic kidney disease during antihypertensive therapy with and without ACE inhibitors. Data Sources: 11 randomized, controlled trials comparing the efficacy of antihypertensive regimens with or without ACE inhibitors for patients with predominantly nondiabetic kidney disease. Study Selection. MEDLINE database search for English-language studies published between 1977 and 1999. Data Extraction: Data on 1860 nondiabetic patients were pooled in a patient-level meta-analysis. Progression of kidney disease was defined as a doubling of baseline serum creatinine level or onset of kidney failure. Multivariable regression analysis was performed to assess the association of systolic and diastolic blood pressure and urine protein excretion with kidney disease progression at 22 610 patient visits. Data Synthesis: Mean duration of follow-up was 2.2 years. Kidney disease progression was documented in 311 patients. Systolic blood pressure of 110 to 129 mm Hg and urine protein excretion less than 2.0 g/d were associated with the lowest risk for kidney disease progression. Angiotensin-converting enzyme inhibitors remained beneficial after adjustment for blood pressure and urine protein excretion (relative risk, 0.67 [95% CI, 0.53 to 0.84]). The increased risk for kidney progression at higher systolic blood pressure levels was greater in patients with urine protein excretion greater than 1.0 g/d (P < 0.006). Conclusion: Although reverse causation cannot be excluded with certainty, a systolic blood pressure goal between 110 and 129 mm Hg may be beneficial in patients with urine protein excretion greater than 1.0 g/d. Systolic blood pressure less than 110 mm Hg may be associated with a higher risk for kidney disease progression.

AB - Background: Angiotensin-converting enzyme (ACE) inhibitors reduce blood pressure and urine protein excretion and slow the progression of chronic kidney disease. Purpose. To determine the levels of blood pressure and urine protein excretion associated with the lowest risk for progression of chronic kidney disease during antihypertensive therapy with and without ACE inhibitors. Data Sources: 11 randomized, controlled trials comparing the efficacy of antihypertensive regimens with or without ACE inhibitors for patients with predominantly nondiabetic kidney disease. Study Selection. MEDLINE database search for English-language studies published between 1977 and 1999. Data Extraction: Data on 1860 nondiabetic patients were pooled in a patient-level meta-analysis. Progression of kidney disease was defined as a doubling of baseline serum creatinine level or onset of kidney failure. Multivariable regression analysis was performed to assess the association of systolic and diastolic blood pressure and urine protein excretion with kidney disease progression at 22 610 patient visits. Data Synthesis: Mean duration of follow-up was 2.2 years. Kidney disease progression was documented in 311 patients. Systolic blood pressure of 110 to 129 mm Hg and urine protein excretion less than 2.0 g/d were associated with the lowest risk for kidney disease progression. Angiotensin-converting enzyme inhibitors remained beneficial after adjustment for blood pressure and urine protein excretion (relative risk, 0.67 [95% CI, 0.53 to 0.84]). The increased risk for kidney progression at higher systolic blood pressure levels was greater in patients with urine protein excretion greater than 1.0 g/d (P < 0.006). Conclusion: Although reverse causation cannot be excluded with certainty, a systolic blood pressure goal between 110 and 129 mm Hg may be beneficial in patients with urine protein excretion greater than 1.0 g/d. Systolic blood pressure less than 110 mm Hg may be associated with a higher risk for kidney disease progression.

UR - http://www.scopus.com/inward/record.url?scp=0141789624&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0141789624&partnerID=8YFLogxK

M3 - Article

VL - 139

JO - Annals of Internal Medicine

JF - Annals of Internal Medicine

SN - 0003-4819

IS - 4

ER -