title: The impact of blood pressure on kidney function in the elderly: a cross-sectional study.
abstract: OBJECTIVE
  Intensive blood pressure (BP) target decreases blood perfusion of kidneys that attenuates the benefits of BP treatment in elderly hypertensive individuals. The optimal BP goal for renal function in the hypertensive elderly has been unclear. We investigated the impact of BP on renal function to define the appropriate BP target in the elderly.
  
  
  METHODS
  A total of 28,258 elderly subjects were categorized into normotensive (Norm), hypotensive (Hypo) and hypertensive (Hyper) groups according to BP levels. Systolic, diastolic and pulse BP (SBP, DBP and PBP) were further stratified by 10 mmHg. Blood urea nitrogen, serum creatinine, uric acid, glomerular filtration rate (GFR), renal insufficiency prevalence (RIP) and proteinuria prevalence (PP) were compared among different groups and BP strata. The RIP and PP in the elderly with obesity, hyperlipidemia or diabetes in Norm, Hypo and Hyper groups were evaluated.
  
  
  RESULTS
  GFR in Hypo and Hyper groups was significantly lower than that in Norm group. The RIP and PP was higher in Hypo and Hyper groups than that in the Norm group. Proteinuria became more prevalent when SBP was >140 mmHg or <90 mmHg. DBP>80 mmHg increased PP while DBP<70 mmHg increased RIP. PBP>60 mmHg led to an increased RIP and PP. Obesity or hyperlipidemia only combined with hypertension caused a significantly increased RIP and PP. Diabetes independent of hypertension contributed to higher RIP and PP.
  
  
  CONCLUSIONS
  The most beneficial BP target for kidney function in the elderly may be SBP of 90-140 mmHg and DBP of 70-80 mmHg. PBP <60 mmHg may be appropriate.
authors.affiliation: Department of Cardiology, Central South University, Changsha, China 410013.
authors.forename: Ya-Ping
authors.initials: YP
authors.lastname: Zhang
authors.forename: Xiao-Cong
authors.initials: XC
authors.lastname: Zuo
authors.forename: Zhi-Jun
authors.initials: ZJ
authors.lastname: Huang
authors.forename: Ze-Min
authors.initials: ZM
authors.lastname: Kuang
authors.forename: Ming-Gen
authors.initials: MG
authors.lastname: Lu
authors.forename: Dayue Darrel
authors.initials: DD
authors.lastname: Duan
authors.forename: Hong
authors.initials: H
authors.lastname: Yuan
mesh_terms: D000368:Aged / Q000502:physiology*; D000465:Algorithms; D044466:Asian People; D001794:Blood Pressure / Q000502:physiology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology; D007022:Hypotension / Q000503:physiopathology; D007668:Kidney / Q000502:physiology*; D007677:Kidney Function Tests; D008297:Male
references.citation: Prim Care. 2005 Dec;32(4):1011-25, viii
references.pmid: 16326225
references.citation: N Engl J Med. 1996 Jan 4;334(1):13-8
references.pmid: 7494564
references.citation: Int J Stroke. 2011 Apr;6(2):144-9
references.pmid: 21371277
references.citation: J Ren Nutr. 2010 Sep;20(5 Suppl):S29-30
references.pmid: 20797567
references.citation: Curr Hypertens Rep. 2011 Dec;13(6):452-5
references.pmid: 21904985
references.citation: Med Clin North Am. 2013 Jan;97(1):75-89
references.pmid: 23290731
references.citation: Nefrologia. 2005;25 Suppl 4:66-71
references.pmid: 16392326
references.citation: J Clin Hypertens (Greenwich). 2009 Jul;11(7):345-7
references.pmid: 19583629
references.citation: J Clin Endocrinol Metab. 1999 Jun;84(6):1862-6
references.pmid: 10372676
references.citation: Am J Physiol Renal Physiol. 2000 May;278(5):F817-22
references.pmid: 10807594
references.citation: N Engl J Med. 2010 Apr 29;362(17):1575-85
references.pmid: 20228401
references.citation: Diabetes Care. 2012 Jan;35 Suppl 1:S64-71
references.pmid: 22187472
references.citation: Zhonghua Liu Xing Bing Xue Za Zhi. 2005 Jul;26(7):478-84
references.pmid: 16334996
references.citation: Expert Opin Pharmacother. 2010 Nov;11(16):2635-50
references.pmid: 20497095
references.citation: CNS Neurosci Ther. 2011 Oct;17(5):577-84
references.pmid: 21951373
references.citation: J Am Soc Nephrol. 2005 Oct;16(10):3027-37
references.pmid: 16120823
references.citation: J Nephrol. 2010 Mar-Apr;23(2):189-93
references.pmid: 20119928
references.citation: Curr Hypertens Rep. 2008 Apr;10(2):138-42
references.pmid: 18474181
references.citation: J Am Coll Cardiol. 2003 Apr 16;41(8):1364-72
references.pmid: 12706933
references.citation: J Clin Hypertens (Greenwich). 2007 Oct;9(10):790-5
references.pmid: 17917507
references.citation: Lancet. 2005 Jan 15-21;365(9455):217-23
references.pmid: 15652604
references.citation: Circulation. 2011 Jun 21;123(24):2799-810, 9 p following 810
references.pmid: 21632497
references.citation: Curr Hypertens Rep. 2008 Feb;10(1):39-45
references.pmid: 18367025
references.citation: Hypertension. 1995 Mar;25(3):305-13
references.pmid: 7875754
references.citation: Curr Atheroscler Rep. 2011 Aug;13(4):298-305
references.pmid: 21626308
references.citation: Maturitas. 2012 Feb;71(2):94-103
references.pmid: 22137331
references.citation: Presse Med. 2012 Nov;41(11):1116-21
references.pmid: 22480861
references.citation: J Intern Med. 2012 Dec;272(6):611-9
references.pmid: 22891848
references.citation: Hypertension. 1995 Oct;26(4):610-5
references.pmid: 7558220
references.citation: J Hypertens. 2009 Nov;27(11):2121-58
references.pmid: 19838131
references.citation: Hypertension. 2003 Jun;41(6):1178-9
references.pmid: 12756222
references.citation: JAMA. 1976 May 24;235(21):2299-306
references.pmid: 946622
references.citation: Clin Nephrol. 2010 Nov;74 Suppl 1:S39-43
references.pmid: 20979962
references.citation: BMJ. 2000 Aug 12;321(7258):412-9
references.pmid: 10938049
references.citation: Ann Intern Med. 2003 Jul 15;139(2):137-47
references.pmid: 12859163
references.citation: Clin J Am Soc Nephrol. 2010 Jun;5(6):1003-9
references.pmid: 20299365
references.citation: J Trauma. 2007 Aug;63(2):291-7; discussion 297-9
references.pmid: 17693826
references.citation: J Am Soc Nephrol. 2006 Dec;17(12 Suppl 3):S194-200
references.pmid: 17130261
references.citation: J Am Soc Nephrol. 2005 Jul;16(7):2170-9
references.pmid: 15930097
references.citation: J Hypertens. 2004 Jan;22(1):11-9
references.pmid: 15106785
references.citation: Med Clin North Am. 2013 Jan;97(1):31-51
references.pmid: 23290728
references.citation: Kidney Int. 2003 Mar;63(3):1121-9
references.pmid: 12631096
references.citation: Circulation. 2005 Aug 16;112(7):969-75
references.pmid: 16087792
references.citation: Arch Intern Med. 2006 Apr 24;166(8):884-9
references.pmid: 16636214
references.citation: J Am Soc Nephrol. 2002 Nov;13(11):2776-82
references.pmid: 12397049
references.citation: Arch Surg. 2011 Jul;146(7):865-9
references.pmid: 21768435
references.citation: J Am Soc Nephrol. 2005 May;16(5):1433-9
references.pmid: 15800126
references.citation: Minerva Med. 2012 Aug;103(4):219-34
references.pmid: 22805616