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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

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Optimal blood pressure for patients with chronic kidney disease: a nationwide population-based cohort study

You-Bin Lee1,2, Ji Sung Lee3, So-Hyeon Hong1

  • 1Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.

Scientific Reports
|January 16, 2021
PubMed

Insights

High blood pressure (BP) increases cardiovascular events and mortality in chronic kidney disease (CKD) patients. Optimal BP targets are crucial; avoid SBP <100 mmHg with antihypertensives to prevent adverse outcomes.

Area of Science:

  • Nephrology and Cardiovascular Medicine
  • Hypertension Management in Chronic Kidney Disease (CKD)

Background:

  • Chronic kidney disease (CKD) patients face elevated risks of cardiovascular events, end-stage renal disease (ESRD), and mortality.
  • The impact of blood pressure (BP) management on these adverse outcomes in CKD, particularly with antihypertensive treatment, requires precise understanding.

Purpose of the Study:

  • To evaluate the association between blood pressure levels and the risk of incident cardiovascular events, ESRD, and mortality in CKD patients.
  • To assess these risks in both treated and untreated CKD patients, identifying optimal BP targets for antihypertensive therapy.

Main Methods:

  • Nationwide cohort study utilizing Korean National Health Insurance Service-Health Screening Cohort data.
  • Analysis of 22,278 adults (≥40 years) with CKD, excluding those with prior cardiovascular disease or ESRD.
  • Hazard ratios for adverse outcomes were analyzed based on systolic BP (SBP) and diastolic BP (DBP) categories, with and without antihypertensive treatment.

Main Results:

  • Elevated SBP (≥130 mmHg) and DBP (≥80 mmHg) were linked to higher risks of adverse outcomes compared to reference BP ranges (SBP 120-129 mmHg, DBP 70-79 mmHg).
  • SBP <100 mmHg was associated with increased all-cause mortality and a composite of ESRD and all-cause mortality, specifically among antihypertensive medication users.
  • A significant proportion of CKD patients had BP levels ≥130/80 mmHg (48.52% SBP, 51.99% DBP).

Conclusions:

  • Maintaining BP <130/80 mmHg is recommended for CKD patients to mitigate hypertension-related risks.
  • For patients on antihypertensive agents, systolic BP should not fall below 100 mmHg to avoid risks associated with undertreatment.
  • These findings highlight the importance of tailored BP targets in CKD management to prevent adverse outcomes from both insufficient and excessive treatment.

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