TY - JOUR
T1 - Systolic blood pressure and mortality among older community-dwelling adults with CKD
AU - Weiss, Jessica W.
AU - Johnson, Eric S.
AU - Petrik, Amanda
AU - Smith, David H.
AU - Yang, Xiuhai
AU - Thorp, Micah L.
N1 - Funding Information:
Support: Funding for this work was provided through the Oregon Clinical and Translational Institute Career development pilot project grant ( UL1 RR024140 ). Dr Weiss is also supported by an Agency for Healthcare Research and Quality T32 training grant ( HS017582 ).
PY - 2010/12
Y1 - 2010/12
N2 - 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.
AB - 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.
KW - Aging
KW - Blood pressure
KW - Chronic kidney disease
KW - Elderly
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U2 - 10.1053/j.ajkd.2010.07.018
DO - 10.1053/j.ajkd.2010.07.018
M3 - Article
C2 - 20961677
AN - SCOPUS:78649446676
SN - 0272-6386
VL - 56
SP - 1062
EP - 1071
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 6
ER -