2013 Issues   /   November 2013

‘Ideal’ Blood Pressure Not Always Best for CKD Patients

By U.S. Medicine

MEMPHIS, TN — What’s considered ideal blood pressure measurement in most situations actually was linked with higher mortality rates in chronic kidney disease compared with patients with moderately elevated BP.

A study led by Csaba P. Kovesdy, MD, chief of nephrology at the Memphis, TN, Veterans Affairs Medical Center, found that patients with systolic blood pressure (SPB) of 130 to 159 mm Hg combined with diastolic blood pressure (DBP) of 70 to 89 mm Hg had the lowest adjusted mortality rates. Highest mortality rates occurred in those for whom both SBP and DBP were concomitantly very high or very low, according to the study published recently in Annals of Internal Medicine.

On the other hand, the authors report, 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.

Researchers sought to determine the ideal BP to decrease mortality rates in patients with nondialysis-dependent CKD, maintaining that previous guidelines were unclear.

The study looked at a historical cohort between 2005 and 2012 at all U.S. VA facilities, focusing on 651,749 veterans with CKD.

Researchers examined all possible combinations of SBP and DBP in 96 categories from lowest (<80/<40 mm Hg) to highest (>210/>120 mm Hg), in 10 mm Hg increments. The results were consistent in subgroups of patients with normal and elevated urinary microalbumin-creatinine ratios.

Study authors caution that the patients they reviewed were mostly male, that proteinuria measurements were missing from a large number and that they lacked the ability to establish causality.

“The optimal BP in patients with CKD seems to be 130 to 159/70 to 89 mm Hg,” according to the report. “It may not be advantageous to achieve ideal SBP at the expense of lower-than-ideal DBP in adults with CKD.”

  1. Kovesdy CP, Bleyer AJ, Molnar MZ, Ma JZ, Sim JJ, Cushman WC, Quarles LD, Kalantar-Zadeh K. Blood pressure and mortality in U.S. veterans with chronic kidney disease: a cohort study. Ann Intern Med. 2013 Aug 20;159(4):233-42. doi: 10.7326/0003-4819-159-4-201308200-00004. PubMed PMID: 24026256.

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