Impact of Blood Pressure Control on Progression of Renal Failure
Michael Epstein
Avram Z. Traum
Strict Blood-Pressure Control and Progression of Renal Failure in Children
ESCAPE (Effect of Strict Blood Pressure Control and ACE Inhibition on the Progression of CRF in Pediatric Patients) Trial Group, Wühl E, Trivelli A, et al. N Engl J Med. 2009;361(17):1639–1650
Background
In adults, tight blood pressure (BP) control, particularly through use of angiotensin converting enzyme inhibitors (ACEi), can delay the progression of chronic kidney disease (CKD) to end stage renal disease (ESRD). Prior to this study, similar efficacy had not been demonstrated in pediatrics, despite the high prevalence of hypertension in children with CKD and its known contribution to ESRD development. Furthermore, benchmarks for optimal BP control had not been established.
Objectives
To compare conventional vs. intensive BP control on the rate of progression of CKD to ESRD in children.
Methods
Randomized controlled trial at 33 European sites from 1998 to 2001.
Patients
385 children ages 3 to 18 with stage II–IV CKD (glomerular filtration rate [GFR] of 15 to 80 mL/min/1.73 m2 body surface area) with hypertension (24-hour mean arterial pressure [MAP] >95th percentile and/or an antihypertensive prescription). Select exclusion criteria: renal artery stenosis, kidney transplant, or other severe organ dysfunction.
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