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Blood Pressure and Mortality in U.S. Veterans With Chronic Kidney Disease: A Cohort Study
Study Questions:
What are the associations of both systolic blood pressure (SBP) and diastolic blood pressure (DBP) with all-cause mortality in patients with nondialysis-dependent chronic kidney disease?
Methods:
This was an observational analysis of 651,749 US veterans with nondialysis-dependent chronic kidney disease. Patients were categorized by mutually exclusive combinations of 15 SBP categories (<80 to ≥210 mm Hg in 10 mm Hg increments) and 10 DBP categories (<40 to ≥120 mm Hg in 10 mm Hg increments). The primary outcome was all-cause mortality.
Results:
Adjusted analyses demonstrated that patients with BP 130-159/70-89 mm Hg had the lowest mortality rates. Patients with moderately elevated SBP combined with DBP no less than 70 mm Hg had consistently lower mortality rates than did patients with ideal SBP combined with DBP <70 mm Hg.
Conclusions:
Among nondialysis-dependent patients with chronic kidney disease, the greatest survival benefit is associated with a BP of 130-159/70-89 mm Hg. A DBP <70 mm Hg may be associated with increased mortality in this population, even when SBP is ideal.
Perspective:
The authors presented sound evidence that lowering DBP to <70 mm Hg may be deleterious and that lower SBP-DBP combinations are only beneficial at DBP >70 mm Hg. The limitations of this observational analysis aside and although clinical trials would provide more definitive data, this analysis should serve to caution against aggressive lowering of DBP, and highlight the benefits associated with a BP target of 130-159/70-89 mm Hg in this population.
Keywords: Renal Insufficiency, Veterans, Cardiology, Blood Pressure, Hypertension
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