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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Blood pressure components and end-stage renal disease in persons with chronic kidney disease: the Kidney Early
Carmen A Peralta1, Keith C Norris, Suying Li
1Department of Medicine, San Francisco VA Medical Center, San Francisco, California, USA. carmenalicia.peralta@ucsf.edu
Insights
High systolic blood pressure (SBP) increases end-stage renal disease (ESRD) risk in chronic kidney disease (CKD) patients, starting at 140 mm Hg. Lowering SBP may be crucial for managing CKD progression.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Public Health
Background:
- Managing hypertension in chronic kidney disease (CKD) is challenging, with ongoing debate regarding optimal blood pressure targets.
- The specific associations between different blood pressure components and the risk of end-stage renal disease (ESRD) are not fully understood.
Purpose of the Study:
- To investigate the relationship between systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP) with the risk of developing ESRD.
- To determine the prevalence and characteristics of uncontrolled hypertension in a CKD population.
Main Methods:
- Analysis of data from 16,129 participants in the Kidney Early Evaluation Program (KEEP) with an estimated glomerular filtration rate (eGFR) of 60 mL/min/1.73 m².
- Utilized Cox proportional hazards models to assess the association between SBP, DBP, PP, and ESRD risk.
- Estimated the prevalence of uncontrolled hypertension defined as SBP ≥ 150 mm Hg or DBP ≥ 90 mm Hg.
Main Results:
- Higher SBP was significantly associated with increased ESRD risk, particularly at levels of 140 mm Hg and above.
- After full adjustment, SBP of 140-149 mm Hg showed a hazard ratio (HR) of 1.27, and SBP ≥ 150 mm Hg had an HR of 1.36 for ESRD.
- Elevated DBP (≥ 90 mm Hg) and PP (≥ 80 mm Hg) were also linked to higher ESRD risk, though SBP appeared to be the primary driver.
- Over 33% of participants had uncontrolled hypertension, predominantly due to isolated systolic hypertension.
Conclusions:
- Elevated SBP is a significant risk factor for ESRD progression in individuals with CKD, with risk apparent at SBP levels of 140 mm Hg.
- The findings suggest that current blood pressure targets for CKD may need re-evaluation, with a focus on lowering SBP more aggressively.
- Treatment strategies emphasizing SBP reduction could be vital for improving blood pressure control and mitigating ESRD risk in the CKD population.
Background:
Treatment of hypertension is difficult in chronic kidney disease (CKD), and blood pressure goals remain controversial. The association between each blood pressure component and end-stage renal disease (ESRD) risk is less well known.
Methods:
We studied associations of systolic and diastolic blood pressure (SBP and DBP, respectively) and pulse pressure (PP) with ESRD risk among 16,129 Kidney Early Evaluation Program (KEEP) participants with an estimated glomerular filtration rate of 60 mL/min/1.73 m(2) using Cox proportional hazards. We estimated the prevalence and characteristics associated with uncontrolled hypertension (SBP ≥ 150 or DBP ≥ 90 mm Hg).
Results:
The mean (SD) age of participants was 69 (12) years; 25% were black, 6% were Hispanic, and 43% had diabetes mellitus. Over 2.87 years, there were 320 ESRD events. Higher SBP was associated with higher ESRD risk, starting at SBP of 140 mm Hg or higher. After sex and age adjustment, compared with SBP lower than 130 mm Hg, hazard ratios (HRs) were 1.08 (95% CI, 0.74-1.59) for SBP of 130 to 139 mm Hg, 1.72 (95% CI, 1.21-2.45) for SBP of 140 to 149 mm Hg, and 3.36 (95% CI, 2.51-4.49) for SBP of 150 mm Hg or greater. After full adjustment, HRs for ESRD were 1.27 (95% CI, 0.88-1.83) for SBP of 140 to 149 mm Hg and 1.36 (95% CI, 1.02-1.85) for SBP of 150 mm Hg or higher. Persons with DBP of 90 mm Hg or higher were at higher risk for ESRD compared with persons with DBP of 60 to 74 mm Hg (HR, 1.81; 95% CI, 1.33-2.45). Higher PP was also associated with higher ESRD risk (HR, 1.44 [95% CI, 1.00-2.07] for PP ≥ 80 mm Hg compared with PP < 50 mm Hg). Adjustment for SBP attenuated this association. More than 33% of participants had uncontrolled hypertension (SBP ≥ 150 mm Hg or DBP ≥ 90 mm Hg), mostly due to isolated systolic hypertension (54%).
Conclusions:
In this large, diverse, community-based sample, we found that high SBP seemed to account for most of the risk of progression to ESRD. This risk started at SBP of 140 mm Hg rather than the currently recommended goal of less than 130 mm Hg, and it was highest among those with SBP of at least 150 mm Hg. Treatment strategies that preferentially lower SBP may be required to improve BP control in CKD.
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