Key result
Chronic kidney disease was not associated with blood pressure control (OR 1.04; 95% CI 0.93-1.15) but was associated with greater medication use and lower diastolic pressures.
Why the study?
Does chronic kidney disease affect the achievement of blood pressure control and the number of antihypertensive medications required in patients with hypertension?
Observational (n=9,985)
Yes
Does chronic kidney disease affect the achievement of blood pressure control and the number of antihypertensive medications required in patients with hypertension?
Odds Ratio: 1.04 (95% CI 0.93–1.15)
In patients with hypertension and CKD, achieving blood pressure targets requires more medications and is associated with wider pulse pressures driven by potentially harmful diastolic hypotension.
May complicate BP target attainment in CKD; leaves open optimal strategies pending randomized trials.
The extent to which chronic kidney disease (CKD) affects achievement of blood pressure targets is not comprehensively understood. We evaluated the effects of CKD (estimated glomerular filtration rate: <60 mL/min per 1.73 m(2)) on achievement of blood pressure control (nondiabetic: <140/90 mm Hg; diabetic: <130/85 mm Hg) using data from the Guidelines for Drug Therapy of Hypertension Trial. This 15-month study obtained outpatient blood pressures from 3 Veteran's Affairs institutions. Among 9985 subjects with hypertension, we evaluated the association of CKD with achieved control and antihypertensive medication use. We also explored the association between the number of antihypertensives and systolic, diastolic, and pulse pressure. After 15 months, 41% of participants met blood pressure targets. CKD was not associated with control (adjusted odds ratio: 1.04; 95% CI: 0.93 to 1.15). However, CKD was associated with higher odds of use of >or=3 medications among nondiabetic subjects (odds ratio: 1.46; 95% CI: 1.25 to 1.71) and diabetic subjects (odds ratio: 1.40; 95% CI: 1.17 to 1.66). A significant interaction was observed between CKD and the number of antihypertensives as determinants of diastolic and pulse pressures. Among non-CKD participants, a greater number of antihypertensives (0 compared with 4) was associated with wider pulse pressure (Delta5.2 mm Hg; P<0.001), mainly because of higher systolic pressures (Delta3.6 mm Hg; P=0.001). Among participants with CKD, although greater numbers of antihypertensives were associated with even wider pulse pressures (Delta8.3 mm Hg; P<0.001), this was primarily because of lower diastolic pressures (Delta4.8 mm Hg; P<0.01). Among participants with CKD, greater use of antihypertensives was associated with lower diastolic pressures. Given recent evidence suggesting adverse effects of diastolic hypotension, these results suggest potential risks in patients with CKD from aggressive attempts to control systolic blood pressure.
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Peralta et al. (2007) conducted an observational in Hypertension and Chronic Kidney Disease (n=9,985). Chronic kidney disease (CKD) vs. Non-CKD participants was evaluated on Achievement of blood pressure control (OR 1.04, 95% CI 0.93 to 1.15). Chronic kidney disease was not associated with blood pressure control (OR 1.04; 95% CI 0.93-1.15) but was associated with greater medication use and lower diastolic pressures.
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