Abstract | BACKGROUND: PURPOSE: DATA SOURCES: 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.
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Authors | 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, AIPRD Study Group |
Journal | Annals of internal medicine
(Ann Intern Med)
Vol. 139
Issue 4
Pg. 244-52
(Aug 19 2003)
ISSN: 1539-3704 [Electronic] United States |
PMID | 12965979
(Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)
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Chemical References |
- Angiotensin-Converting Enzyme Inhibitors
- Antihypertensive Agents
- Creatinine
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Topics |
- Angiotensin-Converting Enzyme Inhibitors
(therapeutic use)
- Antihypertensive Agents
(therapeutic use)
- Blood Pressure
(physiology)
- Chronic Disease
- Creatinine
(blood)
- Disease Progression
- Follow-Up Studies
- Humans
- Hypertension
(drug therapy)
- Kidney Diseases
(complications, physiopathology)
- Proteinuria
(physiopathology)
- Regression Analysis
- Risk Factors
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