LAUSR

We read with interest the article by Obi et al. [1] published in J Intern Med. These Authors performed a post hoc analysis of the Systolic Blood Pressure Intervention Trial (SPRINT). They reported an interaction, with unadjusted P-value = 0.019, between baseline estimated glomerular filtration rate (eGFR) and randomization to the lower systolic blood pressure (SBP) goal of <120 mm Hg on the primary cardiovascular outcome, when a linear relationship was assumed between the effect of the treatment and baseline eGFR. A similar interaction was not found for acute kidney injury (AKI). The authors noted that in the subgroup of participants with baseline eGFR <45 mL min /1.73 m, there was no statistically significant decrease in the risk of the primary cardiovascular outcome; however, the risk for AKI persisted. It was therefore concluded that intensive blood-pressure control may provide little or no benefit and even be harmful to patients with moderate-to-advanced chronic kidney disease (CKD).