Key result
Achieving normotension with antihypertensive treatment in chronic kidney disease patients remained associated with higher cardiovascular mortality compared to untreated normal blood pressure (HR 2.30; 95% CI 1.31-4.03).
Why the study?
Evidence describing general demographics in blood pressure and mortality with chronic kidney disease was sparse in Japan.
How does antihypertensive treatment status affect the risk of cardiovascular mortality in patients with and without chronic kidney disease?
Cohort (n=227,204)
Yes
How does antihypertensive treatment status affect the risk of cardiovascular mortality in patients with and without chronic kidney disease?
Any hypertension treatment status compared to untreated normal blood pressure was associated with a higher risk of cardiovascular mortality, suggesting that preventing the development of hypertension is preferable.
Several recent clinical trials and meta-analyses have shown that lowering blood pressure reduces the risk of cardiovascular disease. However, current evidence that describes general demographics in blood pressure and mortality with chronic kidney disease is sparse in Japan. Using a population-based longitudinal cohort that received annual health checkups in Japan in 2008, hypertensive status, self-reported use of antihypertensive drugs, and prognosis were examined through 2012. Chronic kidney disease was defined as positive proteinuria or estimated glomerular filtration rate <60 ml/min/1.73 m2. Subjects were 40 to 74 years old (n = 227,204) with median 3.6 years follow-up period, and patients with and without chronic kidney disease were analyzed separately (n = 183,586 and n = 43,618, respectively). Cardiovascular disease mortality, comprising coronary heart diseases and stroke as entered in the national death registry using ICD-10 coding, was examined. Among all subjects, 346 deaths (96 in chronic kidney disease and 250 in non-chronic kidney disease) due to cardiovascular disease occurred. Compared with cardiovascular disease mortality in chronic kidney disease patients with untreated normal blood pressure, the multivariable adjusted hazard ratio was 3.08 (95% confidence interval: 1.75-5.41) for those with untreated hypertension, 2.30 (1.31-4.03) for those who became normotensive after treatment, and 3.28 (1.91-5.64) for those who remained hypertensive despite treatment. In non-chronic kidney disease subjects, the ratios were 1.90 (1.33-5.41), 1.95 (1.35-2.80), and 1.77 (1.18-2.66), respectively. These results from a nationwide cohort could be one of representative demographics of controlling blood pressure and cardiovascular disease deaths when treating patients with chronic kidney disease in Japan in recent years. Even after development and spread of anti-hypertensive drugs, preventing development of hypertension is preferable, because any hypertension treatment status comparing untreated normal blood pressure was a risk of cardiovascular mortality at baseline year.
No takes yet. Share an insight, caveat, or question.
Nagai et al. (2019) conducted a cohort in Chronic kidney disease and hypertension (n=227,204). Antihypertensive treatment (achieving normotension) vs. Untreated normal blood pressure was evaluated on Cardiovascular disease mortality (HR 2.30, 95% CI 1.31-4.03). Achieving normotension with antihypertensive treatment in chronic kidney disease patients remained associated with higher cardiovascular mortality compared to untreated normal blood pressure (HR 2.30; 95% CI 1.31-4.03).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: