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Observational Study
. 2017 Nov;92(5):1272-1281.
doi: 10.1016/j.kint.2017.04.030. Epub 2017 Jul 24.

Blood pressure parameters are associated with all-cause and cause-specific mortality in chronic kidney disease

Sankar D Navaneethan  1 , Jesse D Schold  2 , Stacey E Jolly  3 , Susana Arrigain  4 , Matthew F Blum  5 , Wolfgang C Winkelmayer  6 , Joseph V Nally Jr  7
Affiliations
Observational Study

Blood pressure parameters are associated with all-cause and cause-specific mortality in chronic kidney disease

Sankar D Navaneethan et al. Kidney Int. 2017 Nov.

Abstract

Previous observational studies reported J or U-shaped associations between blood pressure parameters and mortality in patients with chronic kidney disease (CKD). Here we examined the associations of different blood pressure levels with various causes of death in a CKD population that included patients with eGFR 15-59 ml/min/1.73 m2 with underlying hypertension receiving at least one antihypertensive agent. We obtained data on date and cause of death from State Department of Health mortality files and classified deaths into three categories: cardiovascular, malignancy-related, and non-cardiovascular/non-malignancy related. Cox models were fitted for overall mortality, and separate competing risk regression models for each major cause of death category, to evaluate their associations with various systolic and diastolic blood pressures. During a median follow-up of 3.9 years, 13,332 of 45,412 patients died. Systolic blood pressures under 100, 100-109, 110-119, and over 150 (vs. 130-139 mm Hg) were associated with higher all-cause and cardiovascular mortality. Systolic blood pressures under 100 mm Hg and 100-109 were associated with higher non-cardiovascular/non-malignancy related mortality. Diastolic blood pressures under 50 and 50-59 (vs. 70-79 mm Hg) were associated with higher all-cause and non-cardiovascular/non-malignancy-related mortality while diastolic blood pressures over 90 mm Hg was associated with higher cardiovascular but lower non-cardiovascular/non-malignancy related mortality. Thus, in a non-dialysis dependent CKD population, systolic blood pressures under 110 and over 150 mm Hg were associated with cardiovascular and non-cardiovascular/non-malignancy related deaths. However, diastolic blood pressure under 60 mm Hg was associated in contrast with all-cause mortality and non-cardiovascular/non-malignancy-related deaths.

Keywords: blood pressure; death; kidney disease; outcomes.

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Figures

Figure 1
Figure 1
Associations (adjusted) between systolic blood pressure and all-cause death in CKD
Figure 2
Figure 2
Associations (adjusted) between systolic and diastolic blood pressure, and various causes of death in CKD.
Figure 3
Figure 3
Associations (adjusted) between diastolic blood pressure and all-cause death in CKD
See this image and copyright information in PMC

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