Different components of blood pressure are associated with increased risk of atherosclerotic cardiovascular disease versus heart failure in advanced chronic kidney disease

Nisha Bansal, Charles E. McCulloch, Feng Lin, Cassianne Robinson-Cohen, Mahboob Rahman, John W. Kusek, Amanda H. Anderson, Dawei Xie, Raymond R. Townsend, Claudia M. Lora, Jackson Wright, Alan S. Go, Akinlolu Ojo, Arnold Alper, Eva Lustigova, Magda Cuevas, Radhakrishna Kallem, Chi yuan Hsu, Lawrence J. Appel, Harold I. FeldmanAlan S. Go, Jiang He, John W. Kusek, James P. Lash, Mahboob Rahman, Raymond R. Townsend

Research output: Contribution to journalArticlepeer-review

Abstract

Blood pressure is a modifiable risk for cardiovascular disease (CVD). Among hemodialysis patients, there is a U-shaped association between blood pressure and risk of death. However, few studies have examined the association between blood pressure and CVD in patients with stage 4 and 5 chronic kidney disease. Here we studied 1795 Chronic Renal Insufficiency Cohort (CRIC) Study participants with estimated glomerular filtration rate <30 ml/min per 1.73 m2 and not on dialysis. The association of systolic (SBP), diastolic (DBP), and pulse pressure with the risk of physician-adjudicated atherosclerotic CVD (stroke, myocardial infarction, or peripheral arterial disease) and heart failure was tested using Cox regression adjusted for demographics, comorbidity and medications. There was a significant association with higher SBP (adjusted hazard ratio 2.04 [95% confidence interval: 1.46–2.84]) for SBP over 140 vs under 120 mmHg, higher DBP (2.52 [1.54–4.11]) for DBP >90 mm Hg versus <80 mm Hg and higher pulse pressure (2.67 [1.82–3.92]) for pulse pressure >68 mm Hg versus <51 mm Hg with atherosclerotic CVD. For heart failure, there was a significant association with higher pulse pressure only (1.42 [1.05–1.92]) for pulse pressure >68 mm Hg versus <51 mmHg, but not for SBP or DBP. Thus, among participants with stage 4 and 5 chronic kidney disease, there was an independent association between higher SBP, DBP, and pulse pressure with the risk of atherosclerotic CVD, whereas only higher pulse pressure was independently associated with a greater risk of heart failure. Further trials are needed to determine whether aggressive reduction of blood pressure decreases the risk of CVD events in patients with stage 4 and 5 chronic kidney disease.

Original languageEnglish (US)
Pages (from-to)1348-1356
Number of pages9
JournalKidney international
Volume90
Issue number6
DOIs
StatePublished - Dec 1 2016

Keywords

  • blood pressure
  • cardiovascular disease
  • chronic kidney disease

ASJC Scopus subject areas

  • Nephrology

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