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Assessment of Vascular Function in Patients With Chronic Kidney Disease
08:50

Assessment of Vascular Function in Patients With Chronic Kidney Disease

Published on: June 16, 2014

Extreme Elevations in Blood Pressure and All-Cause Mortality in a Referred CKD Population: Results from the CRISIS

James Ritchie1, Francesco Rainone, Darren Green

  • 1Vascular Research Group, Department of Renal Medicine, Salford Royal Hospital, Salford M6 8HD, UK.

International Journal of Hypertension
|May 28, 2013
PubMed

Insights

Patients with chronic kidney disease (CKD) and persistent extreme hypertension face increased mortality risk. However, achieving blood pressure control significantly reduces this risk, identifying a potential group for advanced therapies.

Area of Science:

  • Nephrology
  • Cardiology
  • Clinical Medicine

Background:

  • Hypertension is a common complication of chronic kidney disease (CKD).
  • Blood pressure lowering shows clinical benefit in CKD patients.
  • Identifying high-risk subgroups with severe hypertension is crucial.

Purpose of the Study:

  • To identify CKD patients at greatest mortality risk from uncontrolled hypertension.
  • To define the prevalence and characteristics of patients who may benefit from adjunctive therapies.

Main Methods:

  • Analysis of 1691 all-cause CKD patients from the CRISIS study.
  • Grouping patients by baseline blood pressure: target (<140/80 mmHg), elevated (140-190/80-100 mmHg), and extreme (>190 and/or 100 mmHg).
  • Assessing mortality risk over a median 4.5-year follow-up.

Main Results:

  • 77 patients with extreme hypertension at baseline showed no increased mortality risk.
  • 1.2% of patients with extreme hypertension at recruitment and 12 months had significantly increased mortality risk (HR 4.3, P=0.01).
  • Improved blood pressure at 12 months in those with baseline extreme hypertension negated the increased mortality risk (HR 0.86, P=0.5).

Conclusions:

  • Most CKD patients with extreme hypertension can achieve blood pressure control with medication, reducing mortality risk.
  • Approximately 1% of CKD patients have uncontrolled extreme hypertension and an increased mortality risk.
  • This 1% subgroup may benefit from further interventions like renal nerve ablation.

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