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Updated: Jun 9, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Pulse Pressure and Cardiovascular and Kidney Outcomes by Age in the Chronic Renal Insufficiency Cohort (CRIC)
Clara J Fischman1, Raymond R Townsend2, Debbie L Cohen2
1Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Insights
Wide pulse pressure (PP) increases risks for cardiovascular events and kidney failure in chronic kidney disease (CKD) patients. The association of PP with adverse outcomes varies by age, suggesting different underlying mechanisms.
Area of Science:
- Nephrology
- Cardiology
- Geriatrics
Background:
- Wide pulse pressure (PP) is linked to cardiovascular events and chronic kidney disease (CKD) progression.
- PP increases with age, but its differential risk across age groups is not well understood.
Purpose of the Study:
- To investigate the association of pulse pressure (PP) with cardiovascular disease (CVD) events and kidney disease progression in CKD patients.
- To determine if the risks associated with PP differ across various age groups.
Main Methods:
- Utilized Cox proportional hazards models in the Chronic Renal Insufficiency Cohort (CRIC) study.
- Assessed time-updated PP associations with atherosclerotic cardiovascular disease (ASCVD) events or death and a composite kidney outcome (50% eGFR reduction or kidney failure).
- Employed inverse probability weighting to account for time-updated confounders.
Main Results:
- A 10-mmHg increase in PP was associated with a 6% higher risk of ASCVD events/death and a 17% higher risk of the composite kidney outcome.
- Higher PP correlated with increased ASCVD risk in younger individuals (21-61 years) and kidney outcomes in older individuals (71-79 years).
- PP remained a significant predictor for kidney outcomes across all ages and for ASCVD events in the youngest tertile, even after adjusting for systolic blood pressure.
Conclusions:
- The mechanisms linking pulse pressure to adverse cardiovascular and kidney outcomes may differ significantly based on patient age.
- Age-specific risk stratification and management strategies for wide pulse pressure in CKD patients may be warranted.
Background:
Wide pulse pressure (PP) is associated with cardiovascular events and the progression of chronic kidney disease (CKD) to kidney failure. PP naturally widens with age, but it is unclear whether the risks associated with greater PP are the same across all ages.
Methods:
We used Cox proportional hazards models to investigate the association of PP with (i) atherosclerotic cardiovascular disease (ASCVD) events or death and (ii) a 50% reduction in estimated glomerular filtration rate or kidney failure in the chronic renal insufficiency cohort (CRIC). We evaluated the association of time-updated PP with these outcomes, accounting for time-updated confounders using inverse probability weighting.
Results:
Among 5,621 participants with CKD, every 10-mmHg greater PP was associated with a 6% higher risk of an ASCVD event or death (hazard ratio [HR] = 1.06, 95% CI 1.04, 1.08) and 17% higher risk of the composite kidney outcome (HR = 1.17, 95% CI 1.16, 1.18). Greater PP was associated with a higher risk of ASCVD events or death among participants in the lowest age tertile (21-61 years), but a higher risk of the composite kidney outcome in the oldest age tertile (71-79 years). While wide PP in participants that experienced the primary outcomes was predominantly driven by elevated SBP, PP remained significantly associated with the composite kidney outcome across all ages and with ASCVD events or death in the first age tertile when SBP was added to the Cox regression model.
Conclusions:
Our findings suggest that the mechanism by which PP is associated with adverse outcomes may differ by age.
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Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.