Key result
Time-averaged systolic blood pressure exhibited a J-shaped association with incident stroke in elderly patients with chronic kidney disease, where those with systolic blood pressure below 125 mmHg paradoxically faced an increased risk.
Why the study?
Risk factors for stroke in elderly patients with CKD are not well understood, and the influence of SBP on stroke risk in stage 3-5 CKD required investigation.
Does time-averaged systolic blood pressure level affect the risk of stroke in elderly patients with chronic kidney disease?
Cohort (n=665)
No
Does time-averaged systolic blood pressure level affect the risk of stroke in elderly patients with chronic kidney disease?
In elderly patients with chronic kidney disease, intensive blood pressure lowering (SBP <125 mmHg) may paradoxically increase the risk of stroke, suggesting a J-curve phenomenon that differs from the general population.
Answers are grounded in this paper and cite their sources.
Should not yet alter SBP targets in elderly CKD; leaves open whether J-curve reflects causation or confounding.
BACKGROUND: The risk factors for stroke in elderly patients with chronic kidney disease (CKD) are not well understood. This study aimed to explore the influence of systolic blood pressure (SBP) on the risk of stroke in a large cohort of elderly patients with stage 3-5 CKD. METHODS: We retrospectively identified 665 patients hospitalized in Beijing Friendship Hospital from January 2000 to December 2021. Patients were followed up until the occurrence of stroke or death. Multivariate logistic regression analysis and Cox proportional hazard models were used to analyze the risk factors for stroke according to the presence or absence of CKD. The association between CKD and stroke was further evaluated regarding the role of SBP in the hypertensive population. RESULTS: In individuals with CKD, a J-shaped relationship was observed between SBP levels and the risk of stroke. Participants with CKD and an SBP less than 125 mmHg had a significantly higher cumulative stroke survival rate than those whose SBP was between 125 and 139 mmHg. The cumulative stroke survival rate increased progressively for those with SBP higher than 140 mmHg. This J-shaped relationship was not found in patients without CKD. CONCLUSION: In elderly patients with CKD, those with the lowest BP are at increased risk for incident stroke. This phenomenon could be different from that in the general population.
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Fu et al. (2022) conducted a cohort in Hypertension and Chronic Kidney Disease (n=665). Time-averaged systolic blood pressure vs. Different blood pressure strata (e.g., 125-139 mmHg) was evaluated on Occurrence of stroke (OR 1.028, 95% CI 1.011-1.045, p=0.001). Time-averaged systolic blood pressure exhibited a J-shaped association with incident stroke in elderly patients with chronic kidney disease, where those with systolic blood pressure below 125 mmHg paradoxically faced an increased risk.
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