Neurology-Strengthening blood pressure leads to kidney damage and worse prognosis

Brain stroke and chronic kidney disease (CKD) is a serious public health problem
.

CKD, which is mainly characterized by a decrease in estimated glomerular filtration rate (eGFR), is common in stroke patients and is associated with unfavorable results

Stroke

Systolic blood pressure Intervention Trial (SPRINT) reported that post hoc analysis, to strengthen the control of blood pressure increases the incidence of acute kidney injury (AKI), and for patients with moderate to severe CKD little heart blood vessels benefit aspects
.

Heart blood vessels

However, these studies did not include patients with acute stroke
.

In patients with ICH, the second acute intracerebral hemorrhage intensive blood pressure test (INTERACT2) showed that compared with the standard, intensive blood pressure had a moderate improvement in functional results; its post-mortem analysis showed that the effects of early intensive blood pressure reduction were different It is consistent in eGFR

The post-mortem analysis showed that the effect of early strengthening and lowering blood pressure was consistent in different eGFRs

Of the 1,000 randomized treatment patients, 974 were analyzed
.

The median baseline eGFR was 88 (interquartile range: 68, 99) ml/min/1.

73 m2; the baseline eGFR values ​​of 451 (46.
3%), 363 (37.
3%), and 160 (16.
4%) patients were ≥90, 60-89 and <60 ml/min/1.
73m2

Compared with normal eGFR (≥90 ml/min/1.

73 m2), people with an eGFR value <60 ml/min/1.
73 m2 have a higher chance of death or disability, but the eGFR value is 60-89 ml/min/1.
73 m2 People don’t

Among patients with decreased eGFR, the probability of death or disability was significantly higher in the intensive group;

Among the patients with decreased eGFR, the probability of death or disability was significantly higher in the intensive group ; among patients with decreased eGFR, the probability of death or disability was significantly higher in the intensive group;

In patients with eGFR values ​​≥90, 60-89 and <60 ml/min/1.
73 m2, ORs were 0.
89 (95% CI 0.
55-1.
44), 1.
13 (0.
68-1.
89) and 3.
60 (1.
47-8.
80) (interaction The effect of P = 0.
02)
.

The important significance of this study is that it is found that the reduction of eGFR is related to the unfavorable outcome after ICH
.

Original source:
Fukuda-Doi M, Yamamoto H, Koga M, Doi Y, Qureshi AI, Yoshimura S, Miwa K, Ishigami A, Shiozawa M, Omae K, Ihara M, Toyoda K.

Impact of Renal Impairment on Intensive Blood-Pressure -Lowering Therapy and Outcomes in Intracerebral Hemorrhage: Results From ATACH-2.
Neurology.
2021 Jul 1:10.

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