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Association Between More Intensive vs Less Intensive Blood Pressure Lowering and Risk of Mortality in Chronic Kidney Disease Stages 3 to 5

Overview of attention for article published in JAMA Internal Medicine, September 2017
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About this Attention Score

  • In the top 5% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (97th percentile)
  • Good Attention Score compared to outputs of the same age and source (65th percentile)

Citations

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52 Dimensions

Readers on

mendeley
95 Mendeley
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1 CiteULike
Title
Association Between More Intensive vs Less Intensive Blood Pressure Lowering and Risk of Mortality in Chronic Kidney Disease Stages 3 to 5
Published in
JAMA Internal Medicine, September 2017
DOI 10.1001/jamainternmed.2017.4377
Pubmed ID
Authors

Rakesh Malhotra, Hoang Anh Nguyen, Oscar Benavente, Mihriye Mete, Barbara V. Howard, Jonathan Mant, Michelle C. Odden, Carmen A. Peralta, Alfred K. Cheung, Girish N. Nadkarni, Ruth L. Coleman, Rury R. Holman, Alberto Zanchetti, Ruth Peters, Nigel Beckett, Jan A. Staessen, Joachim H. Ix

Abstract

Trials in patients with hypertension have demonstrated that intensive blood pressure (BP) lowering reduces the risk of cardiovascular disease and all-cause mortality but may increase the risk of chronic kidney disease (CKD) incidence and progression. Whether intensive BP lowering is associated with a mortality benefit in patients with prevalent CKD remains unknown. To conduct a systematic review and meta-analysis of randomized clinical trials (RCTs) to investigate if more intensive compared with less intensive BP control is associated with reduced mortality risk in persons with CKD stages 3 to 5. Ovid MEDLINE, Cochrane Library, EMBASE, PubMed, Science Citation Index, Google Scholar, and clinicaltrials.gov electronic databases. All RCTs were included that compared 2 defined BP targets (either active BP treatment vs placebo or no treatment, or intensive vs less intensive BP control) and enrolled adults (≥18 years) with CKD stages 3 to 5 (estimated glomerular filtration rate <60 mL/min/1.73 m2) exclusively or that included a CKD subgroup between January 1, 1950, and June 1, 2016. Two of us independently evaluated study quality and extracted characteristics and mortality events among persons with CKD within the intervention phase for each trial. When outcomes within the CKD group had not previously been published, trial investigators were contacted to request data within the CKD subset of their original trials. All-cause mortality during the active treatment phase of each trial. This study identified 30 RCTs that potentially met the inclusion criteria. The CKD subset mortality data were extracted in 18 trials, among which there were 1293 deaths in 15 924 participants with CKD. The mean (SD) baseline systolic BP (SBP) was 148 (16) mm Hg in both the more intensive and less intensive arms. The mean SBP dropped by 16 mm Hg to 132 mm Hg in the more intensive arm and by 8 mm Hg to 140 mm Hg in the less intensive arm. More intensive vs less intensive BP control resulted in 14.0% lower risk of all-cause mortality (odds ratio, 0.86; 95% CI, 0.76-0.97; P = .01), a finding that was without significant heterogeneity and appeared consistent across multiple subgroups. Randomization to more intensive BP control is associated with lower mortality risk among trial participants with hypertension and CKD. Further studies are required to define absolute BP targets for maximal benefit and minimal harm.

Twitter Demographics

The data shown below were collected from the profiles of 146 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 95 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 95 100%

Demographic breakdown

Readers by professional status Count As %
Student > Bachelor 13 14%
Student > Master 13 14%
Other 13 14%
Researcher 11 12%
Student > Postgraduate 10 11%
Other 35 37%
Readers by discipline Count As %
Medicine and Dentistry 59 62%
Unspecified 13 14%
Nursing and Health Professions 9 9%
Pharmacology, Toxicology and Pharmaceutical Science 5 5%
Biochemistry, Genetics and Molecular Biology 2 2%
Other 7 7%

Attention Score in Context

This research output has an Altmetric Attention Score of 128. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 10 November 2019.
All research outputs
#122,772
of 13,855,967 outputs
Outputs from JAMA Internal Medicine
#871
of 3,729 outputs
Outputs of similar age
#5,414
of 269,053 outputs
Outputs of similar age from JAMA Internal Medicine
#49
of 140 outputs
Altmetric has tracked 13,855,967 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 99th percentile: it's in the top 5% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 3,729 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 131.8. This one has done well, scoring higher than 76% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 269,053 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 97% of its contemporaries.
We're also able to compare this research output to 140 others from the same source and published within six weeks on either side of this one. This one has gotten more attention than average, scoring higher than 65% of its contemporaries.