Optimal blood pressure for patients with chronic kidney disease: a nationwide population-based cohort study

Abstract

The effect of blood pressure (BP) on the incident cardiovascular events, progression to end-stage renal disease (ESRD) and mortality were evaluated among chronic kidney disease (CKD) patients with and without antihypertensive treatment. This nationwide study used the Korean National Health Insurance Service-Health Screening Cohort data. The hazards of outcomes were analysed according to the systolic BP (SBP) or diastolic BP (DBP) among adults (aged >= 40 years) with CKD and without previous cardiovascular disease or ESRD (n=22,278). The SBP and DBP were >= 130 mmHg and >= 80 mmHg in 10,809 (48.52%) and 11,583 (51.99%) participants, respectively. During a median 6.2 years, 1271 cardiovascular events, 201 ESRD incidents, and 1061 deaths were noted. Individuals with SBP >= 130 mmHg and DBP >= 80 mmHg had higher hazards of hypertension-related adverse outcomes compared to the references (SBP 120-129 mmHg and DBP 70-79 mmHg). SBP<100 mmHg was associated with hazards of all-cause death, and composite of ESRD and all-cause death during follow-up only among the antihypertensive medication users suggesting that the BP should be<130/80 mmHg and the SBP should not be<100 mmHg with antihypertensive agents to prevent the adverse outcome risk of insufficient and excessive antihypertensive treatment in CKD patients.