Evidence for Reverse Causality in the Association Between Blood Pressure and Cardiovascular Risk in Patients With...

Area of Science:

• Nephrology
• Cardiology
• Clinical Trials

Background:

• The relationship between blood pressure (BP) and cardiovascular disease (CVD) varies by population, appearing U-shaped in chronic kidney disease (CKD) and loglinear in healthy adults.
• The Study of Heart and Renal Protection (SHARP) trial investigated CVD risk in CKD patients.

Purpose of the Study:

• To examine the association between systolic and diastolic BP and CVD risk in CKD patients.
• To differentiate BP-CVD risk relationships based on prior cardiovascular disease history and subclinical cardiac disease.

Main Methods:

• Utilized data from 8666 participants in the SHARP trial with valid baseline BP and troponin-I measurements.
• Employed Cox regression to analyze the association between BP and cardiovascular events, adjusting for confounders.
• Stratified analysis based on self-reported cardiovascular disease history and plasma troponin-I levels.

Main Results:

• The association between systolic BP and cardiovascular events was U-shaped overall.
• In participants without prior CVD or low subclinical disease risk, a loglinear association was observed, with each 10 mm Hg increase in systolic BP correlating to a 27% higher CVD risk.
• Diastolic BP showed a consistent U-shaped relationship with CVD risk, regardless of CVD history or subclinical disease.

Conclusions:

• Confounding factors may obscure the systolic BP-CVD risk association in CKD patients.
• More intensive systolic BP reduction could be beneficial for patients with moderate-to-advanced CKD.