Systolic Blood Pressure and Mortality Among Older Community-Dwelling Adults With CKD

Weiss, Jessica; Johnson, Eric S.; Petrik, Amanda F.; Smith, David H.; Yang, Xiuhai; Thorp, Micah L.

doi:10.1053/j.ajkd.2010.07.018

Cited by 35 publications

(33 citation statements)

References 18 publications

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“…2 Owing to interaction between the kidney measures and hypertension, the higher relative risk of all-cause mortality conferred by hypertension disappeared at lower eGFR and higher albuminuria. Indeed, as we discussed, 2 this phenomenon has been reported in several studies 3,4 and warrants further investigation.…”

supporting

confidence: 75%

Association of chronic kidney disease with adverse outcomes – Authors' reply

et al. 2013

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supporting

confidence: 75%

Association of chronic kidney disease with adverse outcomes – Authors' reply

et al. 2013

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“…This association appeared to be consistent across various categories of eGFR and in those with and without albuminuria(15). A secondary analysis of the Study of Heart and Renal Protection trial noted that the U-shaped associations of blood pressure with mortality was noted only among CKD patients with underlying cardiovascular disease but not in those with pre-existing cardiovascular disease(16).…”

Section: Discussionmentioning

confidence: 77%

Blood pressure parameters are associated with all-cause and cause-specific mortality in chronic kidney disease

Navaneethan

Schold

Jolly

et al. 2017

Kidney International

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Previous observational studies reported J or U-shaped associations between blood pressure parameters and mortality in patients with chronic kidney disease (CKD). Here we examined the associations of different blood pressure levels with various causes of death in a CKD population that included patients with eGFR 15–59 ml/min/1.73 m2 with underlying hypertension receiving at least one antihypertensive agent. We obtained data on date and cause of death from State Department of Health mortality files and classified deaths into three categories: cardiovascular; malignancy-related; and non-cardiovascular/non-malignancy related. Cox models were fitted for overall mortality, and separate competing risk regression models for each major cause of death category, to evaluate their associations with various systolic and diastolic blood pressures. During a median follow-up of 3.9 years, 13,332 of 45,412 patients died. Systolic blood pressures under 100, 100–109, 110–119, and over 150 (vs. 130–139 mm Hg) were associated with higher all-cause and cardiovascular mortality. Systolic blood pressures under 100 mm Hg and 100–109 were associated with higher non-cardiovascular/non-malignancy related mortality. Diastolic blood pressures under 50 and 50–59 (vs. 70–79 mm Hg) were associated with higher all-cause and non-cardiovascular/non-malignancy-related mortality while diastolic blood pressures over 90 mm Hg was associated with higher cardiovascular but lower non-cardiovascular/non-malignancy related mortality. Thus, in a non-dialysis dependent CKD population, systolic blood pressures under110 and over 150 mm Hg were associated with cardiovascular and non-cardiovascular/non-malignancy related deaths. However, diastolic blood pressures under 60 mm Hg was associated in contrast, with all-cause mortality and non-cardiovascular/non-malignancy-related deaths.

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“…Previous observational studies in the dialysis population and in patients with less severe kidney disease have found that both higher and lower SBP and DBP were associated with a higher risk of death and CVD (9,(14)(15)(16)(17)(18)(19). A recent study by Kovesdy et al examined .600,000 veterans with CKD and found that patients in whom both SBP and DBP were very high or very low had the highest mortality rates (3).…”

Section: Discussionmentioning

confidence: 99%

Association of BP with Death, Cardiovascular Events, and Progression to Chronic Dialysis in Patients with Advanced Kidney Disease

Palit¹,

Chonchol²,

Cheung³

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objective The optimal BP target to reduce adverse clinical outcomes in patients with CKD is unclear. This study examined the relationship between BP and death, cardiovascular events (CVEs), and kidney disease progression in patients with advanced kidney disease.Design, setting, participants, & measurements The relationship of systolic BP (SBP), diastolic BP (DBP), and pulse pressure (PP) with death, CVE, and progression to long-term dialysis was examined in 1099 patients with advanced CKD (eGFR#30 ml/min per 1.7 3m 2 ; not receiving dialysis) who participated in the Homocysteine in Kidney and ESRD study. That study enrolled participants from 2001 to 2003. Cox proportional hazard models were used to examine the association between BP and adverse outcomes.Results The mean6SD baseline eGFR was 1867 ml/min per 1.73 m 2 . During a median follow-up of 2.9 years, 453 patients died, 215 had a CVE, and 615 initiated long-term dialysis. After adjustment for demographic characteristics and confounders, SBP, DBP, and PP were not associated with a higher risk of death. SBP and DBP were also not associated with CVE. The highest quartile of PP was associated with a substantial higher risk of CVE compared with the lowest quartile (hazard ratio [HR], 1.67; 95% confidence interval [95% CI], 1.10 to 2.52). The highest quartiles of SBP (HR, 1.28; 95% CI, 1.01 to 1.61) and DBP (HR, 1.36; 95% CI, 1.07 to 1.73), but not PP, were associated with a higher risk of progression to long-term dialysis compared with the lowest quartile.Conclusions In patients with advanced kidney disease not undergoing dialysis, higher PP was strongly associated with CVE whereas higher SBP and DBP were associated with progression to long-term dialysis. These results suggest that SBP and DBP should not be the only factors considered in determining antihypertensive therapy; elevated PP should also be considered.

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Systolic Blood Pressure and Mortality Among Older Community-Dwelling Adults With CKD

Cited by 35 publications

References 18 publications

Association of chronic kidney disease with adverse outcomes – Authors' reply

Association of chronic kidney disease with adverse outcomes – Authors' reply

Blood pressure parameters are associated with all-cause and cause-specific mortality in chronic kidney disease

Association of BP with Death, Cardiovascular Events, and Progression to Chronic Dialysis in Patients with Advanced Kidney Disease

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