South Korean Study Finds Lower BP Levels Reduces CVD Risk in CKD Patients

In a comparison of target blood pressure (BP) levels in people with chronic kidney disease (CKD) not on dialysis, using BP targets from three separate guidelines, researchers found a significantly higher risk for cardiovascular events, even after meeting some BP targets, according to a study published April 25 in the Journal of the American College of Cardiology. Their work indicates that a systolic BP target of <120 mm Hg, as recommended in the 2021 Kidney Disease: Improving Global Outcomes (KDIGO) BP guideline, would provide better protection against cardiovascular events in this population.

Hyeok-Hee Lee, MD, et al., evaluated the effect of the BP targets in the 2021 KDIGO BP guideline (systolic BP target <120 mm Hg for CKD); the 2017 ACC/AHA guideline (universal target <130/80 mm Hg with or without CKD); and the 2012 KDIGO guideline (<130/80 mm Hg with albuminuria or <140/90 mm Hg without albuminuria).

Using data from 1,939 patients from the Korea National Health and Nutrition Examination Survey and 412,167 patients from the National Health Insurance Service, the researchers found that more patients required BP-lowering treatment when using the 2021 KDIGO guideline (66.1%) compared with 53.7% per the 2012 KDIGO guideline and 60.4% per the 2017 ACC/AHA guideline.

A total of 37,912 new cardiovascular events occurred during the 10-year follow-up. In addition, participants who had BP levels above the 2021 KDIGO guideline target had a “significantly higher” cardiovascular disease risk regardless of whether the other two guideline targets were met, whereas participants who had BP levels within the 2021 KDIGO guideline target had a reduced risk for cardiovascular disease events regardless of whether the other two guideline targets were met.

The researchers predict that more total cardiovascular disease events would be prevented in the CKD population in Korea when achieving the BP goals defined in the 2012 KDIGO guideline, compared with the 2017 ACC/AHA and 2021 KDIGO guidelines (21.7%, 6.3% and 15%, respectively). “This indicates that the new 2021 KDIGO guideline would have a profound impact on the population-level prevention of [cardiovascular disease] events,” they conclude.

In an accompanying editorial comment, Alexander G. Logan, MD, notes that a multipronged approach will be required to address the increase in the number of patients who will need more rigorous treatment. “The Korean study provides valuable new information on the group of patients with elevated diastolic BP levels and normal systolic BP who would not receive treatment based on the 2021 KDIGO BP treatment recommendations,” he writes.

Clinical Topics: Prevention, Hypertension

Keywords: Hypertension, Renal Dialysis, National Health Programs, Cardiology, Renal Insufficiency, Chronic, Follow-Up Studies, Albuminuria, Nutrition Surveys, Cardiovascular Diseases, ACC International

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