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

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

Research output: Contribution to journalArticle

26 Citations (Scopus)

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 2) in a community-based health maintenance organization. Predictor Baseline systolic blood pressure (SBP) 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 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 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 2010

Fingerprint

Independent Living
Chronic Renal Insufficiency
Blood Pressure
Mortality
Hospitalization
Hospitalization Insurance
Health Maintenance Organizations
Causality
Dialysis

Keywords

  • Aging
  • Blood pressure
  • Chronic kidney disease
  • Elderly

ASJC Scopus subject areas

  • Nephrology

Cite this

Systolic blood pressure and mortality among older community-dwelling adults with CKD. / Weiss, Jessica; Johnson, Eric S.; Petrik, Amanda; Smith, David H.; Yang, Xiuhai; Thorp, Micah L.

In: American Journal of Kidney Diseases, Vol. 56, No. 6, 12.2010, p. 1062-1071.

Research output: Contribution to journalArticle

Weiss, Jessica ; Johnson, Eric S. ; Petrik, Amanda ; Smith, David H. ; Yang, Xiuhai ; Thorp, Micah L. / Systolic blood pressure and mortality among older community-dwelling adults with CKD. In: American Journal of Kidney Diseases. 2010 ; Vol. 56, No. 6. pp. 1062-1071.
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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 2) in a community-based health maintenance organization. Predictor Baseline systolic blood pressure (SBP) 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 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 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.",
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