Journal
KIDNEY INTERNATIONAL
Volume 90, Issue 6, Pages 1348-1356Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.kint.2016.08.009
Keywords
blood pressure; cardiovascular disease; chronic kidney disease
Categories
Funding
- National Institute of Diabetes and Digestive and Kidney Diseases [U01DK060990, U01DK060984, U01DK061022, U01DK061021, U01DK061028, U01DK060980, U01DK060963, U01DK060902]
- Perelman School of Medicine at the University of Pennsylvania Clinical and Translational Science Award NIH/National Center for Advancing Translational Sciences [UL1TR000003, K01 DK092353]
- Johns Hopkins University [UL1 TR-000424]
- University of Maryland [GCRC M01 RR-16500]
- Clinical and Translational Science Collaborative of Cleveland from the National Center for Advancing Translational Sciences component of the NIH [UL1TR000439]
- NIH road map for Medical Research
- Michigan Institute for Clinical and Health Research (MICHR) [UL1TR000433]
- University of Illinois at Chicago National Center for Advancing Translational Sciences [UL1RR029879]
- Tulane University Translational Research in Hypertension and Renal Biology [P30GM103337]
- Kaiser Permanente [NIH/NCRR UCSF-CTSI UL1 RR-024131]
- [K23 DK088865]
- [R01 DK70939]
- [K24 DK92291]
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Blood pressure is a modifiable risk for cardiovascular disease (CVD). Among hemodialysis patients, there is a U-shaped association between blood pressure and risk of death. However, few studies have examined the association between blood pressure and CVD in patients with stage 4 and 5 chronic kidney disease. Here we studied 1795 Chronic Renal Insufficiency Cohort (CRIC) Study participants with estimated glomerular filtration rate <30 ml/min per 1.73 m(2) and not on dialysis. The association of systolic (SBP), diastolic (DBP), and pulse pressure with the risk of physician-adjudicated atherosclerotic CVD (stroke, myocardial infarction, or peripheral arterial disease) and heart failure was tested using Cox regression adjusted for demographics, comorbidity and medications. There was a significant association with higher SBP (adjusted hazard ratio 2.04 [95% confidence interval: 1.46-2.84]) for SBP over 140 vs under 120 mmHg, higher DBP (2.52 [1.54-4.11]) for DBP >90 mm Hg versus <80 mm Hg and higher pulse pressure (2.67 [1.82-3.92]) for pulse pressure >68 mm Hg versus <51 mm Hg with atherosclerotic CVD. For heart failure, there was a significant association with higher pulse pressure only (1.42 [1.05-1.92]) for pulse pressure >68 mm Hg versus <51 mmHg, but not for SBP or DBP. Thus, among participants with stage 4 and 5 chronic kidney disease, there was an independent association between higher SBP, DBP, and pulse pressure with the risk of atherosclerotic CVD, whereas only higher pulse pressure was independently associated with a greater risk of heart failure. Further trials are needed to determine whether aggressive reduction of blood pressure decreases the risk of CVD events in patients with stage 4 and 5 chronic kidney disease.
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