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. 2022 Dec;44(1):1677-1686.
doi: 10.1080/0886022X.2022.2131574.

Timed-averaged blood pressure showed a J-curve association with stroke in elderly chronic kidney disease patients

Chen Fu  1 , Dongliang Zhang  1 , Haiping Chen  2 , Hui Zhang  3
Affiliations

Timed-averaged blood pressure showed a J-curve association with stroke in elderly chronic kidney disease patients

Chen Fu et al. Ren Fail. 2022 Dec.

Abstract

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.

Keywords: Chronic kidney disease; J-curve; blood pressure; elderly population; stroke.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1.
Figure 1.
A flow diagram showing the application of exclusion criteria when enrolling participants in a study of systolic blood pressure and stroke in elderly individuals with chronic kidney disease.
Figure 2.
Figure 2.
The relationship between the severity of hypertension and the prevalence of stroke in elderly patients with and without chronic kidney disease (CKD).
Figure 3.
Figure 3.
(A) The hazard ratio of stroke across different groups. (B) The cumulative survival rate for risk of stroke according to different groups.
See this image and copyright information in PMC

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