CKD patients under pressure
J- or U-shaped: this is how the associations between blood pressure (BP) and mortality have previously been described in patients with chronic kidney disease (CKD). In the present study, nephrologists at the Cleveland Clinic in Ohio aimed to analyze these relationships in more detail.
The authors included data of 45,412 CKD patients (eGFR 15-59ml/min/m2, at least one antihypertensive drug) and classified all deaths (n=13,332) during the three-year follow-up in three categories according to cause: cardiovascular, malignancy, or non-cardiovascular/non-malignancy.
The main results: both systolic blood pressures < 100, 100-109, 110-119 as well as > 150 were associated with higher all-cause and cardiovascular mortality vs. 130-139 mm Hg. Classified by cause of death, systolic BPs < 100mmHg as well as 100-109mmHg were associated with higher non-cardiovascular/non-malignancy related mortality. Similarly, diastolic BP <50 and 50-59 were associated with higher all-cause and non-cardiovascular/non-malignancy-related mortality (vs. 70-79), while by contrast diastolic BPs > 90 was associated with higher cardiovascular but lower non-cardiovascular/non-malignancy related mortality.
The study confirmed that systolic BPs <110 and >150mmH were associated with cardiovascular and non-cardiovascular/non-malignancy related deaths. Diastolic BPs should also be noted: a value < 60mmHg is associated with all-cause mortality and non-cardiovascular/non-malignancy-related deaths.