BACKGROUND: The ideal blood pressure (BP) to decrease mortality rates in patients with non-dialysis-dependent chronic kidney disease (CKD) is unclear. OBJECTIVE: To assess the association of BP (defined as the combination of systolic BP [SBP] and diastolic BP [DBP] at the individual level) with death in patients with CKD. DESIGN: Historical cohort between 2005 and 2012. SETTING: All U.S. Department of Veterans Affairs health care facilities. PATIENTS: 651 749 U.S. veterans with CKD. MEASUREMENTS: All possible combinations of SBP and DBP were examined in 96 categories from lowest (<80/<40 mm Hg) to highest (>210/>120 mm Hg), in 10-mm Hg increments. Associations with all-cause mortality were examined in time-dependent Cox models with adjustment for relevant confounders. RESULTS: Patients with SBP of 130 to 159 mm Hg combined with DBP of 70 to 89 mm Hg had the lowest adjusted mortality rates, and those in whom both SBP and DBP were concomitantly very high or very low had the highest mortality rates. Patients with moderately elevated SBP combined with DBP no less than 70 mm Hg had consistently lower mortality rates than did patients with ideal SBP combined with DBP less than 70 mm Hg. Results were consistent in subgroups of patients with normal and elevated urinary microalbumin-creatinine ratios. LIMITATION: Mostly male patients, inability to establish causality, and large number of patients missing proteinuria measurement. CONCLUSION: The optimal BP in patients with CKD seems to be 130 to 159/70 to 89 mm Hg. It may not be advantageous to achieve ideal SBP at the expense of lower-than-ideal DBP in adults with CKD. PRIMARY FUNDING SOURCE: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, and U.S. Department of Veterans Affairs.
BACKGROUND: The ideal blood pressure (BP) to decrease mortality rates in patients with non-dialysis-dependent chronic kidney disease (CKD) is unclear. OBJECTIVE: To assess the association of BP (defined as the combination of systolic BP [SBP] and diastolic BP [DBP] at the individual level) with death in patients with CKD. DESIGN: Historical cohort between 2005 and 2012. SETTING: All U.S. Department of Veterans Affairs health care facilities. PATIENTS: 651 749 U.S. veterans with CKD. MEASUREMENTS: All possible combinations of SBP and DBP were examined in 96 categories from lowest (<80/<40 mm Hg) to highest (>210/>120 mm Hg), in 10-mm Hg increments. Associations with all-cause mortality were examined in time-dependent Cox models with adjustment for relevant confounders. RESULTS:Patients with SBP of 130 to 159 mm Hg combined with DBP of 70 to 89 mm Hg had the lowest adjusted mortality rates, and those in whom both SBP and DBP were concomitantly very high or very low had the highest mortality rates. Patients with moderately elevated SBP combined with DBP no less than 70 mm Hg had consistently lower mortality rates than did patients with ideal SBP combined with DBP less than 70 mm Hg. Results were consistent in subgroups of patients with normal and elevated urinary microalbumin-creatinine ratios. LIMITATION: Mostly male patients, inability to establish causality, and large number of patients missing proteinuria measurement. CONCLUSION: The optimal BP in patients with CKD seems to be 130 to 159/70 to 89 mm Hg. It may not be advantageous to achieve ideal SBP at the expense of lower-than-ideal DBP in adults with CKD. PRIMARY FUNDING SOURCE: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, and U.S. Department of Veterans Affairs.
Authors: Paul K Whelton; Jiang He; Lawrence J Appel; Jeffrey A Cutler; Stephen Havas; Theodore A Kotchen; Edward J Roccella; Ron Stout; Carlos Vallbona; Mary C Winston; Joanne Karimbakas Journal: JAMA Date: 2002-10-16 Impact factor: 56.272
Authors: P C van den Hoogen; E J Feskens; N J Nagelkerke; A Menotti; A Nissinen; D Kromhout Journal: N Engl J Med Date: 2000-01-06 Impact factor: 91.245
Authors: Preston S Klassen; Edmund G Lowrie; Donal N Reddan; Elizabeth R DeLong; Joseph A Coladonato; Lynda A Szczech; J Michael Lazarus; William F Owen Journal: JAMA Date: 2002-03-27 Impact factor: 56.272
Authors: Jerzy Gasowski; Robert H Fagard; Jan A Staessen; Tomasz Grodzicki; Stuart Pocock; Florent Boutitie; François Gueyffier; Jean-Pierre Boissel Journal: J Hypertens Date: 2002-01 Impact factor: 4.844
Authors: Jackson T Wright; George Bakris; Tom Greene; Larry Y Agodoa; Lawrence J Appel; Jeanne Charleston; DeAnna Cheek; Janice G Douglas-Baltimore; Jennifer Gassman; Richard Glassock; Lee Hebert; Kenneth Jamerson; Julia Lewis; Robert A Phillips; Robert D Toto; John P Middleton; Stephen G Rostand Journal: JAMA Date: 2002-11-20 Impact factor: 56.272
Authors: Michael Domanski; Gary Mitchell; Marc Pfeffer; James D Neaton; James Norman; Kenneth Svendsen; Richard Grimm; Jerome Cohen; Jeremiah Stamler Journal: JAMA Date: 2002 May 22-29 Impact factor: 56.272
Authors: Se Won Oh; Sang Youb Han; Kum Hyun Han; Ran-hui Cha; Sejoong Kim; Sun Ae Yoon; Dong-Ryeol Rhu; Jieun Oh; Eun Young Lee; Dong Ki Kim; Yon Su Kim Journal: Hypertens Res Date: 2015-08-27 Impact factor: 3.872
Authors: Jessica W Weiss; Dawn Peters; Xiuhai Yang; Amanda Petrik; David H Smith; Eric S Johnson; Micah L Thorp; Cynthia Morris; Ann M O'Hare Journal: Clin J Am Soc Nephrol Date: 2015-08-14 Impact factor: 8.237
Authors: Harald Sourij; Roland Edlinger; Friedrich Prischl; Martin Auinger; Alexandra Kautzky-Willer; Marcus D Säemann; Rudolf Prager; Martin Clodi; Guntram Schernthaner; Gert Mayer; Rainer Oberbauer; Alexander R Rosenkranz Journal: Wien Klin Wochenschr Date: 2016-04 Impact factor: 1.704
Authors: Csaba P Kovesdy; Ahmed Alrifai; Elvira O Gosmanova; Jun Ling Lu; Robert B Canada; Barry M Wall; Adriana M Hung; Miklos Z Molnar; Kamyar Kalantar-Zadeh Journal: Clin J Am Soc Nephrol Date: 2016-04-21 Impact factor: 8.237
Authors: Rakesh Malhotra; Ronit Katz; Daniel E Weiner; Andrew S Levey; Alfred K Cheung; Andrew G Bostom; Joachim H Ix Journal: Am J Hypertens Date: 2019-08-14 Impact factor: 2.689
Authors: Xing Song; Lemuel R Waitman; Yong Hu; Alan S L Yu; David C Robbins; Mei Liu Journal: J Am Med Inform Assoc Date: 2019-03-01 Impact factor: 4.497
Authors: Csaba P Kovesdy; Keith C Norris; L Ebony Boulware; Jun L Lu; Jennie Z Ma; Elani Streja; Miklos Z Molnar; Kamyar Kalantar-Zadeh Journal: Circulation Date: 2015-09-18 Impact factor: 29.690