• Naveen Rathi, Paul K Whelton, Glenn M Chertow, William C Cushman, Alfred K Cheung, Guo Wei, Robert Boucher, Paul L Kimmel, Adam P Bress, Holly J Kramer, Catreena Al-Marji, Tom Greene, and Srinivasan Beddhu.
• Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.
• Am. J. Hypertens. 2019 Nov 15; 32 (12): 1170-1177.

BackgroundMore than one-third of US adults have prediabetes, which is typically accompanied by hypertension.MethodsWe examined whether prediabetes modified the effects of intensive systolic blood pressure (SBP) lowering on the incidence of chronic kidney disease (CKD) and acute kidney injury (AKI) events in a post-hoc analysis of the Systolic Blood Pressure Intervention Trial (SPRINT). Diabetes was a SPRINT exclusion criterion. We defined normoglycemia and prediabetes as fasting plasma glucose <100 mg/dl and ≥100 mg/dl, respectively.ResultsOf the 9,323 participants included in this analysis, 3,898 (41.8%) had prediabetes and the rest (5,425) had normoglycemia. In participants with baseline estimated glomerular filtration rate (eGFR) ≥60 ml/min/1.73 m2, incident CKD was defined as a ≥30% decline in eGFR to below 60 ml/min/1.73 m2 with repeat confirmation. AKI events were identified clinically. In the non-CKD participants (n = 6,678), there were 164 incident CKD events. The hazard ratios (HRs) for incident CKD for intensive SBP goal (<120 mm Hg) vs. standard SBP goal (<140 mm Hg) in the normoglycemia (HR: 3.25, 95% CI: 2.03, 5.19) and prediabetes (HR: 3.90, 95% CI: 2.17, 7.02) groups were similar (interaction P value 0.64). In the entire analytic cohort (N = 9,323), there were 310 AKI events. AKI HRs for intensive vs. standard SBP in the normoglycemia (HR: 1.59, 95% CI: 1.17, 2.15) and prediabetes (HR: 1.74, 95% CI: 1.22, 2.48) groups were also similar (interaction P value 0.71).ConclusionsPrediabetes was highly prevalent, but there was no evidence that prediabetes modified the effects of SPRINT intervention on kidney events.CLINICAL TRIALS REGISTRATIONNCT01206062.© Published by Oxford University Press on behalf of American Journal of Hypertension Ltd 2019.

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