Dataset Information

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.

SUBMITTER: Yoon SY

PROVIDER: S-EPMC11010022 | biostudies-literature | 2024 Mar

REPOSITORIES: biostudies-literature

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Publications

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

Yoon Soo-Young SY Kong Ji Yoon JY Jeong Su Jin SJ Kim Jin Sug JS Hwang Hyeon Seok HS Jeong Kyunghwan K

Journal of the American Heart Association 20240312 6

<h4>Background</h4>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.<h4>Methods and results</h4>Participants who were >20 years old and had estimated glomerular filtration rate 15 to 60 mL/min per 1.73 m<sup>2</sup> during 2009 to 2011 were included from the data ...[more]

PMID: 38471824

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Project description:Background and objectivesThe Systolic Blood Pressure Intervention Trial (SPRINT) demonstrated that intensive BP lowering reduced the risk of cardiovascular disease, but increased eGFR decline. Serum parathyroid hormone (PTH) and fibroblast growth factor-23 (FGF23) concentrations are elevated in CKD and are associated with cardiovascular disease. We evaluated whether intact PTH or intact FGF23 concentrations modify the effects of intensive BP control on cardiovascular events, heart failure, and all-cause mortality in SPRINT participants with CKD.Design, setting, participants, & measurementsWe measured PTH and FGF23 in 2486 SPRINT participants with eGFR<60 ml/min per 1.73 m2 at baseline. Cox models were used to evaluate whether serum PTH and FGF23 concentrations were associated with cardiovascular events, heart failure, and all-cause mortality, and whether PTH and FGF23 modified the effects of intensive BP control.ResultsThe mean age of this subcohort was 73 years, 60% were men, and mean eGFR was 46±11 ml/min per 1.73 m2. Median PTH was 48 (interquartile range [IQR], 35-67) pg/ml and FGF23 was 66 (IQR, 52-88) pg/ml. There were 261 composite cardiovascular events, 102 heart failure events, and 179 deaths within the subcohort. The adjusted hazard ratio (HR) per doubling of PTH concentration for cardiovascular events, heart failure, and all-cause mortality were 1.29 (95% confidence interval [95% CI], 1.06 to 1.57), 1.32 (95% CI, 0.96 to 1.83), and 1.04 (95% CI, 0.82 to 1.31), respectively. There were significant interactions between PTH and BP arm for both the cardiovascular (P-interaction=0.01) and heart failure (P-interaction=0.004) end points. Participants with a PTH above the median experienced attenuated benefits of intensive BP control on cardiovascular events (adjusted HR, 1.02; 95% CI, 0.72 to 1.42) compared with participants with a PTH below the median (adjusted HR, 0.67; 95% CI, 0.45 to 1.00). FGF23 was not independently associated with any outcome and did not modify the effects of the intervention.ConclusionsSPRINT participants with CKD and a high serum PTH received less cardiovascular protection from intensive BP therapy than participants with a lower serum PTH.

Dataset Information

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

Background

Methods and results

Conclusions

Publications

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

Similar Datasets

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