SBP below, above 100–120 mm Hg tied to increased death risk in CKD patients

The divergence of systolic blood pressure (SBP) above or below 100–120 mm Hg appears to increase the risk of all-cause mortality among patients with chronic kidney disease (CKD), especially among those on antihypertensive medication, suggests a study.

A total of 13,414 individuals with CKD stages 1–4 from NHANES general population datasets from 1999 to 2004 and followed until 31 December 2010 were included in this retrospective cohort study. The authors used multivariate analysis and Kaplan–Meier curves to assess SBP and other risk factors associated with overall mortality in each CKD stage.

SBP <100 mm Hg correlated with significantly higher mortality in individuals with death rates of 9 percent, 12 percent, 30 percent, and 54 percent in baseline CKD stages 1, 2, 3, 4, respectively, adjusted for age, sex, and race in stages 2, 3, and 4.

Excluding <100 mm Hg as a continuous variable revealed that higher SBP also correlated with fully adjusted increased mortality risk in those on (hazard ratio [HR, 1.006 per mm Hg; p=0.0006) or not on antihypertensive medication (HR, 1.006 per mm Hg; p<0.0001).

Among individuals taking antihypertensive medication, SBP <100 mm Hg or in each 20 mm Hg categorical group >120 mm Hg contributed to an adjusted risk of increased mortality. In addition, increasing age, men, smoking, diabetes, and comorbidities were associated with heightened mortality risk.

“These findings support the recent guideline of an optimal target goal SBP of 100–120 mm Hg in patients with CKD stages 1–4,” the authors said.