What is the clinical evidence from this study?

Study design: Cohort. Population: Chronic kidney disease (n=22278). Intervention: Systolic blood pressure 140-149 mmHg vs. Systolic blood pressure 120-129 mmHg. Primary outcome: Composite of progression to end-stage renal disease and all-cause death (HR 1.443, 95% CI 1.190-1.751, p=<0.0001).

January 15, 2021Scientific ReportsOpen Access

Optimal blood pressure for patients with chronic kidney disease: a nationwide population-based cohort study

Q: What are the key findings of this study?

Systolic blood pressure of 140-149 mmHg significantly increased the hazard of end-stage renal disease and all-cause death (HR 1.443) compared to 120-129 mmHg in adults with chronic kidney disease.

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Key result

Systolic blood pressure of 140-149 mmHg significantly increased the hazard of end-stage renal disease and all-cause death (HR 1.443) compared to 120-129 mmHg in adults with chronic kidney disease.

Why the study?

The effect of blood pressure on incident cardiovascular events, progression to end-stage renal disease, and mortality needed evaluation among chronic kidney disease patients with and without antihypertensive treatment.

Does maintaining systolic blood pressure at 120-129 mmHg and diastolic blood pressure at 70-79 mmHg improve the composite outcome of ESRD and all-cause death in adults with chronic kidney disease?

Population

22,278 adults aged ≥ 40 years with CKD without previous cardiovascular disease or ESRD in Korea

Comparison

Different SBP and DBP categories vs reference (SBP 120-129 mmHg and DBP 70-79 mmHg)

Design

Nationwide population-based cohort study

Follow-up

Median 6.2 years

Authors

YLYou‐Bin LeeSamsung Medical Center JLJi Sung LeeChonnam National University SHSo‐hyeon HongEwha Womans University

Discussion

Member takes

Implication

SBP 140-149 mmHg was associated with higher ESRD and mortality risk in CKD; extends observational data but leaves optimal targets open for RCTs.

Study Design

Type

Cohort (n=22,278)

Multicenter

Yes

Structured PICO

Does maintaining systolic blood pressure at 120-129 mmHg and diastolic blood pressure at 70-79 mmHg improve the composite outcome of ESRD and all-cause death in adults with chronic kidney disease?

Population

22,278 adults aged ≥ 40 years with chronic kidney disease and without previous cardiovascular disease or end-stage renal disease, followed for a median of 6.2 years.

Exposure

Systolic blood pressure (SBP) ≥ 130 mmHg or < 100 mmHg, and diastolic blood pressure (DBP) ≥ 80 mmHg (observational exposure, stratified by antihypertensive medication use)

Comparator

Reference blood pressure range of systolic BP 120-129 mmHg and diastolic BP 70-79 mmHg

Outcome

Composite of end-stage renal disease (ESRD) and all-cause death during follow-upcomposite

Main Result

Hazard Ratio: 1.443 (95% CI 1.19–1.751)

Absolute Event Rate: 14.7% vs 7.22%

p-value: p=<0.0001

In patients with chronic kidney disease, maintaining a blood pressure of 120-129/70-79 mmHg is optimal, as both higher blood pressures and excessive lowering (SBP < 100 mmHg) with antihypertensive medications are associated with increased risks of ESRD and mortality.

Limitations

Effect of residual unmeasured confounders may remain
Blood pressure measurement devices were heterogenous across institutions
Did not include ambulatory or home blood pressure measurements
Categories of blood pressure were defined based on measurements at a single timepoint
Chronic kidney disease was defined only based on eGFR without reflecting other features like albuminuria
Study population consisted of Korean adults, so results should be extrapolated to other ethnic groups with caution
Residual unmeasured confounders
Heterogenous BP measurement devices across institutions
Lack of ambulatory or home BP measurements
Categories of BP defined based on a single timepoint measurement
CKD defined only by eGFR without quantitative albuminuria measures
Study population limited to Korean adults

Cite This Study

Lee et al. (2021) conducted a cohort in Chronic kidney disease (n=22,278). Systolic blood pressure 140-149 mmHg vs. Systolic blood pressure 120-129 mmHg was evaluated on Composite of progression to end-stage renal disease and all-cause death (HR 1.443, 95% CI 1.190-1.751, p=<0.0001). Systolic blood pressure of 140-149 mmHg significantly increased the hazard of end-stage renal disease and all-cause death (HR 1.443) compared to 120-129 mmHg in adults with chronic kidney disease.

synapsesocial.com/papers/6a2a48db05fb49e469113bca https://doi.org/10.1038/s41598-021-81328-y

Topics

Hypertension management Women and heart disease Cardiovascular prevention

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Implication

SBP 140-149 mmHg was associated with higher ESRD and mortality risk in CKD; extends observational data but leaves optimal targets open for RCTs.

Optimal blood pressure for patients with chronic kidney disease: a nationwide population-based cohort study

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Topics

Optimal blood pressure for patients with chronic kidney disease: a nationwide population-based cohort study

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Topics

Also Consider