Intensive Home Blood Pressure Lowering in Patients With Advanced CKD.

We conducted a pilot trial of intensive BP control to determine if lower home systolic BP (SBP) targets can be safely achieved for patients with CKD through titration of BP medications using in-home measured BP.

我们进行了一项积极血压控制的试点试验，以确定是否可以通过使用家庭测量的血压调整血压药物，安全地为慢性肾病患者实现更低的家庭收缩压（SBP）目标。

study_design

Nonblinded randomized controlled trial. SETTING & PARTICIPANTS: 108 patients with advanced CKD (estimated glomerular filtration rate≤30mL/min/1.73m2) and hypertension.

非盲法随机对照试验。

Methods

Participants were randomized either to a target SBP goal of<120mm Hg (N=66) or a less intensive SBP goal (N=42).

参与者被随机分配至目标收缩压<120mmHg（N=66）或较不严格的收缩压目标（N=42）。

Antihypertensive medications were titrated to achieve the target home SBP range in the first 4 months of the study and maintained until the end of the study.

研究的前4个月内，抗高血压药物被调整以达到目标家庭收缩压范围，并维持至研究结束。

Home BP was measured using a wireless Bluetooth-enabled monitor that transmitted readings to providers in real-time.

家庭血压是使用无线蓝牙连接的监测器测量的，该监测器可以实时将读数传输给提供者。

outcome

The primary efficacy outcome was the difference in achieved clinic SBP between the 2 study arms from months 4-12.

主要疗效结果是两组研究对象在第4至12个月期间实现的临床收缩压(SBP)的差异。

Safety outcomes included hyperkalemia, a composite outcome of falls or syncope, and onset of need for dialysis or kidney transplantation.

安全性结果包括高钾血症、跌倒或晕厥的复合结果，以及开始需要透析或肾脏移植的发病。

Results

The mean clinic SBP at month 12 was 124.7mm Hg in the intensive SBP group versus 138.2mm Hg in the less intensive SBP group.

在第12个月，强化收缩压(SBP)组的平均临床SBP为124.7毫米汞柱，而较不强化SBP组为138.2毫米汞柱。

Averaged over months 4-12, the achieved mean clinic SBP in the intensive SBP arm was 11.7mm Hg ([95% CI, 7.5-16], P<0.001), lower than the mean SBP achieved in the less intensive SBP arm.

在第4至12个月期间，强化SBP组的平均临床SBP为11.7毫米汞柱（95%置信区间[7.5-16]，P<0.001），低于较不强化SBP组所达到的平均SBP。

Primary safety outcomes were not statistically significantly different between the 2 arms (all P>0.05).

主要安全性结果在两组之间没有统计学上的显著差异（所有P>0.05）。

limitations

Small sample size, which may have limited our ability to detect clinically significant differences in rates of adverse outcomes, and single-center design.

样本量小，这可能限制了我们检测不良结果发生率中临床上显著差异的能力，以及单中心设计。

Conclusions

A clinic SBP goal of<120mm Hg is feasible to achieve with the help of real-time home BP monitoring and appears to be safe in this study population with advanced CKD.

通过实时家庭血压监测的帮助，实现收缩压目标<120mm Hg是可行的，并且在这个晚期慢性肾脏病（CKD）研究人群中似乎是安全的。

Larger trials to determine optimal BP targets in advanced CKD and the risks and benefits associated with more intensive BP control are warranted.

需要更大规模的试验来确定晚期CKD中最佳的血压目标，以及更密集血压控制相关的风险和益处。

funding

Grant from an educational institution (UCSF Research Allocation Program award).

教育机构资助（UCSF研究分配计划奖）

trial_registration

Registered at ClinicalTrials.gov with study number NCT02975505.

在ClinicalTrials.gov注册，研究编号为NCT02975505。

PLAIN-LANGUAGE SUMMARY: We conducted a pilot trial to test the feasibility of lowering blood pressure (BP) intensively through the use of home BP monitoring in patients with low kidney function.

简易语言总结：我们进行了一项试点试验，以测试通过家庭血压监测在肾功能低下患者中积极降低血压（BP）的可行性。

We found that home BP monitoring used to guide antihypertensive medication dosing permitted better BP control for patients with chronic kidney disease and did not appear to be associated with major adverse events.

我们发现，使用家庭血压监测来指导抗高血压药物剂量的调整，使得慢性肾脏病患者的血压控制得更好，并且似乎并未与重大不良事件相关联。