Blood pressure and mortality in U.S. Veterans with chronic kidney disease

A cohort study

Csaba Kovesdy, Anthony J. Bleyer, Miklos Z. Molnar, Jennie Z. Ma, John J. Sim, William Cushman, Leigh Quarles, Kamyar Kalantar-Zadeh

Research output: Contribution to journalArticle

121 Citations (Scopus)

Abstract

Background: The ideal blood pressure (BP) to decrease mortality rates in patients with non-dialysis-dependent chronic kidney disease (CKD) is unclear. Objective: To assess the association of BP (defined as the combination of systolic BP [SBP] and diastolic BP [DBP] at the individual level) with death in patients with CKD. Design: Historical cohort between 2005 and 2012. Setting: All U.S. Department of Veterans Affairs health care facilities. Patients: 651 749 U.S. veterans with CKD. Measurements: All possible combinations of SBP and DBP were examined in 96 categories from lowest (80/40 mm Hg) to highest (>120/>120 mm Hg), in 10-mm Hg increments. Associations with all-cause mortality were examined in time-dependent Cox models with adjustment for relevant confounders. Results: Patients with SBP of 130 to 159 mm Hg combined with DBP of 70 to 89 mm Hg had the lowest adjusted mortality rates and those in whom both SBP and DBP were concomitantly very high or very low had the highest mortality rates. Patients with moderately elevated SBP combined with DBP no less than 70 mm Hg had consistently lower mortality rates than did patients with ideal SBP combined with DBP less than 70 mm Hg. Results were consistent in subgroups of patients with normal and elevated urinary microalbumin-creatinine ratios. Limitation: Mostly male patients, inability to establish causality, and large number of patients missing proteinuria measurement. Conclusion: The optimal BP in patients with CKD seems to be 130 to 159/70 to 89 mm Hg. It may not be advantageous to achieve ideal SBP at the expense of lower-than-ideal DBP in adults with CKD.

Original languageEnglish (US)
Pages (from-to)233-242
Number of pages10
JournalAnnals of internal medicine
Volume159
Issue number4
DOIs
StatePublished - Aug 20 2013

Fingerprint

Veterans
Chronic Renal Insufficiency
Cohort Studies
Blood Pressure
Mortality
Veterans Health
Health Facilities
Proteinuria
Proportional Hazards Models
Causality
Creatinine
Delivery of Health Care

All Science Journal Classification (ASJC) codes

  • Internal Medicine

Cite this

Blood pressure and mortality in U.S. Veterans with chronic kidney disease : A cohort study. / Kovesdy, Csaba; Bleyer, Anthony J.; Molnar, Miklos Z.; Ma, Jennie Z.; Sim, John J.; Cushman, William; Quarles, Leigh; Kalantar-Zadeh, Kamyar.

In: Annals of internal medicine, Vol. 159, No. 4, 20.08.2013, p. 233-242.

Research output: Contribution to journalArticle

Kovesdy, Csaba ; Bleyer, Anthony J. ; Molnar, Miklos Z. ; Ma, Jennie Z. ; Sim, John J. ; Cushman, William ; Quarles, Leigh ; Kalantar-Zadeh, Kamyar. / Blood pressure and mortality in U.S. Veterans with chronic kidney disease : A cohort study. In: Annals of internal medicine. 2013 ; Vol. 159, No. 4. pp. 233-242.
@article{fd2690884da744159f4c80137396913c,
title = "Blood pressure and mortality in U.S. Veterans with chronic kidney disease: A cohort study",
abstract = "Background: The ideal blood pressure (BP) to decrease mortality rates in patients with non-dialysis-dependent chronic kidney disease (CKD) is unclear. Objective: To assess the association of BP (defined as the combination of systolic BP [SBP] and diastolic BP [DBP] at the individual level) with death in patients with CKD. Design: Historical cohort between 2005 and 2012. Setting: All U.S. Department of Veterans Affairs health care facilities. Patients: 651 749 U.S. veterans with CKD. Measurements: All possible combinations of SBP and DBP were examined in 96 categories from lowest (80/40 mm Hg) to highest (>120/>120 mm Hg), in 10-mm Hg increments. Associations with all-cause mortality were examined in time-dependent Cox models with adjustment for relevant confounders. Results: Patients with SBP of 130 to 159 mm Hg combined with DBP of 70 to 89 mm Hg had the lowest adjusted mortality rates and those in whom both SBP and DBP were concomitantly very high or very low had the highest mortality rates. Patients with moderately elevated SBP combined with DBP no less than 70 mm Hg had consistently lower mortality rates than did patients with ideal SBP combined with DBP less than 70 mm Hg. Results were consistent in subgroups of patients with normal and elevated urinary microalbumin-creatinine ratios. Limitation: Mostly male patients, inability to establish causality, and large number of patients missing proteinuria measurement. Conclusion: The optimal BP in patients with CKD seems to be 130 to 159/70 to 89 mm Hg. It may not be advantageous to achieve ideal SBP at the expense of lower-than-ideal DBP in adults with CKD.",
author = "Csaba Kovesdy and Bleyer, {Anthony J.} and Molnar, {Miklos Z.} and Ma, {Jennie Z.} and Sim, {John J.} and William Cushman and Leigh Quarles and Kamyar Kalantar-Zadeh",
year = "2013",
month = "8",
day = "20",
doi = "10.7326/0003-4819-159-4-201308200-00004",
language = "English (US)",
volume = "159",
pages = "233--242",
journal = "Annals of Internal Medicine",
issn = "0003-4819",
publisher = "American College of Physicians",
number = "4",

}

TY - JOUR

T1 - Blood pressure and mortality in U.S. Veterans with chronic kidney disease

T2 - A cohort study

AU - Kovesdy, Csaba

AU - Bleyer, Anthony J.

AU - Molnar, Miklos Z.

AU - Ma, Jennie Z.

AU - Sim, John J.

AU - Cushman, William

AU - Quarles, Leigh

AU - Kalantar-Zadeh, Kamyar

PY - 2013/8/20

Y1 - 2013/8/20

N2 - Background: The ideal blood pressure (BP) to decrease mortality rates in patients with non-dialysis-dependent chronic kidney disease (CKD) is unclear. Objective: To assess the association of BP (defined as the combination of systolic BP [SBP] and diastolic BP [DBP] at the individual level) with death in patients with CKD. Design: Historical cohort between 2005 and 2012. Setting: All U.S. Department of Veterans Affairs health care facilities. Patients: 651 749 U.S. veterans with CKD. Measurements: All possible combinations of SBP and DBP were examined in 96 categories from lowest (80/40 mm Hg) to highest (>120/>120 mm Hg), in 10-mm Hg increments. Associations with all-cause mortality were examined in time-dependent Cox models with adjustment for relevant confounders. Results: Patients with SBP of 130 to 159 mm Hg combined with DBP of 70 to 89 mm Hg had the lowest adjusted mortality rates and those in whom both SBP and DBP were concomitantly very high or very low had the highest mortality rates. Patients with moderately elevated SBP combined with DBP no less than 70 mm Hg had consistently lower mortality rates than did patients with ideal SBP combined with DBP less than 70 mm Hg. Results were consistent in subgroups of patients with normal and elevated urinary microalbumin-creatinine ratios. Limitation: Mostly male patients, inability to establish causality, and large number of patients missing proteinuria measurement. Conclusion: The optimal BP in patients with CKD seems to be 130 to 159/70 to 89 mm Hg. It may not be advantageous to achieve ideal SBP at the expense of lower-than-ideal DBP in adults with CKD.

AB - Background: The ideal blood pressure (BP) to decrease mortality rates in patients with non-dialysis-dependent chronic kidney disease (CKD) is unclear. Objective: To assess the association of BP (defined as the combination of systolic BP [SBP] and diastolic BP [DBP] at the individual level) with death in patients with CKD. Design: Historical cohort between 2005 and 2012. Setting: All U.S. Department of Veterans Affairs health care facilities. Patients: 651 749 U.S. veterans with CKD. Measurements: All possible combinations of SBP and DBP were examined in 96 categories from lowest (80/40 mm Hg) to highest (>120/>120 mm Hg), in 10-mm Hg increments. Associations with all-cause mortality were examined in time-dependent Cox models with adjustment for relevant confounders. Results: Patients with SBP of 130 to 159 mm Hg combined with DBP of 70 to 89 mm Hg had the lowest adjusted mortality rates and those in whom both SBP and DBP were concomitantly very high or very low had the highest mortality rates. Patients with moderately elevated SBP combined with DBP no less than 70 mm Hg had consistently lower mortality rates than did patients with ideal SBP combined with DBP less than 70 mm Hg. Results were consistent in subgroups of patients with normal and elevated urinary microalbumin-creatinine ratios. Limitation: Mostly male patients, inability to establish causality, and large number of patients missing proteinuria measurement. Conclusion: The optimal BP in patients with CKD seems to be 130 to 159/70 to 89 mm Hg. It may not be advantageous to achieve ideal SBP at the expense of lower-than-ideal DBP in adults with CKD.

UR - http://www.scopus.com/inward/record.url?scp=84882244594&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84882244594&partnerID=8YFLogxK

U2 - 10.7326/0003-4819-159-4-201308200-00004

DO - 10.7326/0003-4819-159-4-201308200-00004

M3 - Article

VL - 159

SP - 233

EP - 242

JO - Annals of Internal Medicine

JF - Annals of Internal Medicine

SN - 0003-4819

IS - 4

ER -