Prognostic significance of home blood pressure control on renal and cardiovascular outcomes in elderly patients with chronic kidney disease.
The influence of home blood pressure (HBP) control on renal and cardiovascular outcomes is not fully defined, and the optimal blood pressure (BP) target in elderly patients with chronic kidney disease (CKD) remains unknown. To clarify the influence of HBP on the progression of CKD and the occurrence of cardiovascular events in elderly CKD patients, we recruited 104 patients with stage 3 to 5 CKD, who were > or =70 years of age. The mean follow-up duration was 39+/-15 months. HBP was measured every morning and evening for 7 consecutive days. HBP data were obtained every 6 months for 79 of these patients. There were significant correlations observed between morning systolic BP (SBP), evening SBP and the change in estimated glomerular filtration rate (eGFR) during the follow-up period (baseline/follow-up; morning r=-0.55/-0.51, evening r=-0.48/-0.38, all P<0.0001, baseline: baseline values, follow-up: mean values obtained every 6 months during the follow-up period). Stepwise multivariate regression analysis identified morning SBP and urinary protein excretion as independent predictors of a change in eGFR during the follow-up period. Cox proportional hazards analysis showed that baseline morning SBP, baseline evening SBP and follow-up morning SBP were significantly associated with an increased risk of renal events (hazard ratios; 1.04 (95% CI, 1.01-1.07), 1.06 (1.02-1.09) and 1.10 (1.04-1.17), respectively). However, Cox proportional hazards analyses showed that there was no significant association between BP and the risk of cardiovascular events. In conclusion, even among elderly CKD patients, HBP is a significant predictor of decline in renal function and the development of end-stage renal disease. In addition, the optimal target BP for elderly CKD patients needs to be clarified.
Okada
Tomonari
T
Department of Nephrology, Tokyo Medical University, Japan. t-okada@tokyo-med.ac.jp
Nakao
Toshiyuki
T
Matsumoto
Hiroshi
H
Nagaoka
Yume
Y
Tomaru
Ryo
R
Iwasawa
Hideaki
H
Wada
Toshikazu
T
D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D007564:Japan / Q000453:epidemiology; D008297:Male; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011507:Proteinuria / Q000453:epidemiology; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D012307:Risk Factors
D000959:Antihypertensive Agents