Association of the Intensive Blood Pressure Target and Cardiovascular Outcomes in the Population With Chronic Kidney Disease: A Retrospective Study in Korea

Abstract

Background: Recently, the target systolic blood pressure (BP) <120 mm Hg was suggested in the population with chronic kidney disease. We aimed to determine the applicability of intensified BP and to assess the incidence of cardiovascular disease (CVD) in the population with chronic kidney disease.

Methods and results: Participants who were >20 years old and had estimated glomerular filtration rate 15 to 60 mL/min per 1.73 m² during 2009 to 2011 were included from the database of Korean National Health Insurance Service and were followed up to 2018. Participants were categorized by BP as <120/80 mm Hg; 120 to 129/<80 mm Hg; 130 to 139/80 to 89 mm Hg; ≥140/90 mm Hg. The primary outcome was CVD risk and the secondary outcomes were all-cause mortality and progression to end-stage renal disease followed by subgroup analysis. Among the 45 263 adults with chronic kidney disease, 5196 CVD events were noted. In Cox regression analysis, higher BP was associated with a higher risk for CVD (hazard ratio [HR], 1.15 [95% CI, 1.12-1.19]; P for trend <0.001), end-stage renal disease (HR, 1.29 [95% CI, 1.22-1.37]; P for trend <0.001), and all-cause mortality (HR, 1.09 [95% CI, 1.06-1.13]; P for trend <0.001) than BP <120/80 mm Hg. In subgroup analysis, the association between BP and CVD showed a different trend in participants taking antihypertensives compared with those not using antihypertensive drugs. When comparing BP-treated individuals to untreated individuals, a significant interaction in the association between BP categories and end-stage renal disease was observed.

Conclusions: The new intensive BP target proposed by 2021 Kidney Disease: Improving Global Outcomes should be applied to patients with chronic kidney disease in a personalized and advisory manner.

Keywords: all‐cause mortality; blood pressure; cardiovascular disease; chronic kidney disease; end‐stage renal disease.

Figure 1. Flow diagram of the study population.

After exclusion, a total of 42 563 adults with CKD were included in the final study population. ACEi indicates angiotensin‐converting enzyme inhibitors; ARB, angiotensin II receptor blockers; CKD, chronic kidney disease; and eGFR, estimated glomerular filtration rate.

Figure 2. Kaplan–Meier curves according to blood pressure categories in chronic kidney disease population.

A, Event‐free probability of cardiovascular disease. B, End‐stage renal disease. C, All‐cause mortality. BP indicates blood pressure.