Association of the Intensive Blood Pressure Target and Cardiovascular Outcomes in the Population With Chronic Kidney...

Area of Science:

• Nephrology
• Cardiology
• Public Health

Background:

• Recent guidelines suggest a systolic blood pressure (BP) target <120 mmHg for individuals with chronic kidney disease (CKD).
• The applicability and impact of intensified BP targets on cardiovascular disease (CVD) incidence in CKD populations require thorough investigation.

Purpose of the Study:

• To evaluate the effectiveness of intensified blood pressure management in CKD patients.
• To assess the incidence of cardiovascular disease (CVD) and other adverse outcomes in relation to varying BP levels within the CKD population.

Main Methods:

• Analysis of a large cohort (45,263 adults) with CKD (eGFR 15-60 mL/min/1.73 m²) from the Korean National Health Insurance Service database (2009-2018).
• Participants were categorized by BP levels: <120/80, 120-129/<80, 130-139/80-89, and ≥140/90 mmHg.
• Cox regression analysis was used to determine the association between BP categories and primary (CVD risk) and secondary outcomes (all-cause mortality, end-stage renal disease [ESRD]).

Main Results:

• Higher BP levels were significantly associated with increased risks of CVD (HR, 1.15), ESRD (HR, 1.29), and all-cause mortality (HR, 1.09) compared to BP <120/80 mmHg.
• Subgroup analyses revealed differential associations between BP and CVD risk based on antihypertensive medication use.
• A significant interaction was observed between BP categories and ESRD risk in treated versus untreated individuals.

Conclusions:

• The findings suggest that the intensive BP target (<120/80 mmHg) may not be universally applicable to all CKD patients.
• A personalized and advisory approach is recommended when applying the 2021 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines for BP management in CKD.
• Further research is needed to refine BP targets based on individual patient characteristics and treatment status.