How Low Can You Go? Blood Pressure and Mortality in Chronic Kidney Disease

Editorials20 August 2013How Low Can You Go? Blood Pressure and Mortality in Chronic Kidney DiseaseDena E. Rifkin, MD, MS and Mark J. Sarnak, MD, MSDena E. Rifkin, MD, MSFrom University of California, San Diego and Veterans Affairs Healthcare System, San Diego, California; and Tufts Medical Center, Boston, Massachusetts.Search for more papers by this author and Mark J. Sarnak, MD, MSFrom University of California, San Diego and Veterans Affairs Healthcare System, San Diego, California; and Tufts Medical Center, Boston, Massachusetts.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-159-4-201308200-00014 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Several studies document a U-shaped relationship between systolic blood pressure (SBP) and death in kidney failure (1, 2) and stage 4 and 5 chronic kidney disease (CKD) (3). Whether patients with early CKD also have increased mortality rates with both low and high SBP is unclear. In a clinical trial of proteinuric diabetic nephropathy, SBP less than 120 mm Hg or diastolic blood pressure (DBP) less than 85 mm Hg were associated with adverse cardiovascular outcomes (4). In other hypertensive populations, low DBP has been associated with increased risk for death (5). Low DBP may exert its ill effects through ...References1. Kalantar-Zadeh K, Kilpatrick RD, McAllister CJ, Greenland S, and Kopple JD. Reverse epidemiology of hypertension and cardiovascular death in the hemodialysis population: the 58th annual fall conference and scientific sessions. Hypertension. 2005;45:811-7. [PMID: 15699452] CrossrefMedlineGoogle Scholar2. Zager PG, Nikolic J, Brown RH, Campbell MA, Hunt WC, Peterson D, et al. “U” curve association of blood pressure and mortality in hemodialysis patients. Medical Directors of Dialysis Clinic, Inc. Kidney Int. 1998;54:561-9. [PMID: 9690224] MedlineGoogle Scholar3. Kovesdy CP, Trivedi BK, Kalantar-Zadeh K, and Anderson JE. Association of low blood pressure with increased mortality in patients with moderate to severe chronic kidney disease. Nephrol Dial Transplant. 2006;21:1257-62. [PMID: 16421161] CrossrefMedlineGoogle Scholar4. Berl T, Hunsicker LG, Lewis JB, Pfeffer MA, Porush JG, Rouleau JL, et al. Collaborative Study Group. Impact of achieved blood pressure on cardiovascular outcomes in the Irbesartan Diabetic Nephropathy Trial. J Am Soc Nephrol. 2005;16:2170-9. [PMID: 15930097] CrossrefMedlineGoogle Scholar5. Messerli FH, Mancia G, Conti CR, Hewkin AC, Kupfer S, Champion A, et al. Dogma disputed: can aggressively lowering blood pressure in hypertensive patients with coronary artery disease be dangerous? Ann Intern Med. 2006;144:884-93 LinkGoogle Scholar6. KDIGO Blood Pressure Work Group. KDIGO Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease. Kidney Int Suppl. 2012;2:337-414. Google Scholar7. Shastri S and Sarnak MJ. Blood pressure target in individuals without diabetes: what is the evidence? Am J Kidney Dis. 2010;56:434-8. [PMID: 20570424] CrossrefMedlineGoogle Scholar8. Kovesdy CP, Bleyer AJ, Molnar MZ, Ma JZ, Sim JJ, Cushman WC, et al. Blood pressure and mortality in U.S. veterans with chronic kidney disease. A cohort study. Ann Intern Med. 2013;159:233-42. LinkGoogle Scholar9. O'Hare AM, Choi AI, Bertenthal D, Bacchetti P, Garg AX, Kaufman JS, et al. Age affects outcomes in chronic kidney disease. J Am Soc Nephrol. 2007;18:2758-65. [PMID: 17855638] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Dena E. Rifkin, MD, MS; Mark J. Sarnak, MD, MSAffiliations: From University of California, San Diego and Veterans Affairs Healthcare System, San Diego, California; and Tufts Medical Center, Boston, Massachusetts.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-1605.Corresponding Author: Dena E. Rifkin, MD, MS, Veterans Affairs Healthcare System, 3350 La Jolla Village Drive, #9111H, La Jolla, CA 92093-9111; e-mail, [email protected].Current Author Addresses: Dr. Rifkin: Veterans Affairs Healthcare System, 3350 La Jolla Village Drive, #9111H, La Jolla, CA 92093-9111.Dr. Sarnak: Division of Nephrology, Tufts Medical Center, Box 391, 800 Washington Street, Boston, MA 02111. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoBlood Pressure and Mortality in U.S. Veterans With Chronic Kidney Disease Csaba P. Kovesdy , Anthony J. Bleyer , Miklos Z. Molnar , Jennie Z. Ma , John J. Sim , William C. Cushman , L. Darryl Quarles , and Kamyar Kalantar-Zadeh Metrics 20 August 2013Volume 159, Issue 4Page: 302-303KeywordsAlgorithmsBlood pressureCardiovascular disease riskCardiovascular diseasesChronic kidney diseaseClinical trialsCoronary arteriesDeath ratesElderlyKidneysMedical risk factorsPopulation statisticsProteinsProteinuriaRenal diseasesStiffnessSystolic pressureTreatment guidelinesVascular diseases ePublished: 20 August 2013 Issue Published: 20 August 2013 Copyright & PermissionsCopyright © 2013 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...