Systolic blood pressure and mortality among older community-dwelling adults with CKD

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

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26 Scopus citations

Abstract

Background Chronic kidney disease (CKD) is an increasingly common condition, especially in older adults. CKD manifests differently in older versus younger patients, with a risk of death that far outweighs the risk of CKD progressing to the point that dialysis is required. Current CKD guidelines recommend a blood pressure target <130/80 mm Hg for all patients with CKD; however, it is unknown how lower versus higher baseline blood pressures may affect older adults with CKD. Study Design Retrospective cohort study. Setting & Participants Older patients (aged <75 years) with CKD (estimated glomerular filtration rate <60 mL/min/1.73 m2) in a community-based health maintenance organization. Predictor Baseline systolic blood pressure (SBP) <130, 130-160 (reference group), and >160 mm Hg. Outcomes Participants were followed up for 5 years to examine rates of mortality (primary outcome) and cardiovascular disease hospitalizations (secondary outcome). Results At baseline, 3,099 participants (38.5%) had SBP <130 mm Hg, 3,772 (46.9%) had SBP of 131-160 mm Hg, and 1,171 (14.6%) had SBP >160 mm Hg. A total of 3,734 (46.4%) died and 2,881 (35.8%) were hospitalized. Adjusted HRs for mortality in the groups with SBP <130 and >160 mm Hg were 1.22 (95% CI, 1.11-1.34) and 1.06 (95% CI, 0.93-1.22), respectively. Adjusted HRs for cardiovascular hospitalization in these groups were 1.10 (95% CI, 0.99-1.23) and 1.26 (95% CI, 1.09-1.45), respectively. Limitations Although causality should not be inferred from this retrospective analysis, results from this study can generate hypotheses for future randomized controlled trials to investigate the relationship between blood pressure and outcomes in older patients with CKD. Conclusions Our study suggests that lower baseline SBP (≤130 mm Hg) may predict poorer outcomes in terms of both mortality and cardiovascular hospitalizations in older adults with CKD. Conversely, higher baseline SBP (>160 mm Hg) may predict increased risk of cardiovascular hospitalizations, but does not predict mortality. Clinical trials are required to test this hypothesis.

Original languageEnglish (US)
Pages (from-to)1062-1071
Number of pages10
JournalAmerican Journal of Kidney Diseases
Volume56
Issue number6
DOIs
StatePublished - Dec 1 2010

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Keywords

  • Aging
  • Blood pressure
  • Chronic kidney disease
  • Elderly

ASJC Scopus subject areas

  • Nephrology

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