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Updated: Mar 22, 2026
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Age and Outcomes Associated with BP in Patients with Incident CKD
Csaba P Kovesdy1,2, Ahmed Alrifai1, Elvira O Gosmanova3,4
1Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee.
Insights
Systolic blood pressure (SBP) increases risks for cardiovascular outcomes in chronic kidney disease (CKD) patients, but this association is reduced in older adults. Diastolic blood pressure (DBP) showed no consistent links to vascular outcomes in CKD.
Area of Science:
- Nephrology
- Cardiology
- Geriatrics
Background:
- Hypertension is a key treatable risk factor for cardiovascular disease.
- Optimal blood pressure (BP) targets for elderly patients with chronic kidney disease (CKD) remain unclear.
- CKD affects a significant elderly population, necessitating research into age-specific BP management.
Purpose of the Study:
- To investigate the association between systolic blood pressure (SBP) and diastolic blood pressure (DBP) and major adverse cardiovascular outcomes in patients with incident CKD.
- To determine if age modifies the relationship between BP and outcomes such as all-cause mortality, coronary heart disease (CHD), ischemic stroke, and end-stage renal disease (ESRD).
Main Methods:
- A large cohort study of 339,887 patients with incident CKD (eGFR<60 ml/min per 1.73 m(2)) was analyzed.
- Multivariable-adjusted survival models were used to examine associations of SBP and DBP with mortality, CHD, stroke, and ESRD.
- Analyses were stratified by age categories to assess potential interactions.
Main Results:
- Both SBP and DBP exhibited a U-shaped association with mortality.
- SBP showed a linear association with CHD, stroke, and ESRD.
- Higher SBP (>140 mmHg) was linked to increased risk of adverse outcomes, with risk attenuation in older patients (especially those ≥80 years).
- The association between higher SBP and adverse outcomes was significantly reduced in patients aged 80 years and older.
- DBP did not show a consistent association with vascular outcomes.
Conclusions:
- In patients with incident CKD, SBP is associated with adverse cardiovascular outcomes, but this association is less pronounced in older individuals.
- The risk associated with elevated SBP is markedly reduced in the oldest age groups (≥80 years).
- DBP does not appear to have a consistent association with vascular outcomes in patients with incident CKD.
Background And Objectives:
Hypertension is the most important treatable risk factor for cardiovascular outcomes. Many patients with CKD are elderly, but the ideal BP in these individuals is unknown.
Design, Setting, Participants, & Measurements:
From among 339,887 patients with incident eGFR<60 ml/min per 1.73 m(2), we examined associations of systolic BP (SBP) and diastolic BP (DBP) with all-cause mortality, incident coronary heart disease (CHD), ischemic strokes, and ESRD from the time of developing CKD until the end of follow-up (July 26, 2013, for mortality, CHD, and stroke, and December 31, 2011, for ESRD) in multivariable-adjusted survival models categorized by patients' age.
Results:
Of the total cohort, 300,424 (88%) had complete data for multivariable analysis. Both SBP and DBP showed a U-shaped association with mortality. SBP displayed a linear association with CHD, stroke, and ESRD, whereas DBP showed no consistent association with either. SBP>140 mmHg was associated with higher incidence of all examined outcomes, but with an incremental attenuation of the observed risk in older compared with younger patients (P<0.05 for interaction) The adjusted hazard ratios and 95% confidence intervals associated with SBP≥170 mmHg (compared with 130-139 mmHg) in patients <50, 50-59, 60-69, 70-79, and ≥80 years were 1.95 (1.34 to 2.84), 2.01 (1.75 to 2.30), 1.68 (1.49 to 1.89), 1.39 (1.25 to 1.54), and 1.30 (1.17 to 1.44), respectively. The risk of incident CHD, stroke, and ESRD was incrementally higher with higher SBP in patients aged <80 years but showed no consistent association in those aged ≥80 years (P<0.05 for interaction for all outcomes).
Conclusions:
In veterans with incident CKD, SBP showed different associations in older versus younger patients. The association of higher SBP with adverse outcomes was present but markedly reduced in older individuals, especially in those aged ≥80 years. Elevated DBP showed no consistent association with vascular outcomes in patients with incident CKD.
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