title: Systolic blood pressure and outcomes in stage 3-4 chronic kidney disease patients: evidence from a Taiwanese cohort.
abstract: BACKGROUND
  Systolic blood pressure (SBP) goal for chronic kidney disease (CKD) patients is ≤140mm Hg. However, the SBP target provides no suggested lower limit, and some studies indicate that a lower SBP target may be harmful. We aimed to investigate the J-shaped relationship between SBP and clinical outcomes in CKD patients and the factors that modify this relationship.
  
  
  METHODS
  This prospective observational study enrolled 2,144 CKD stage 3-4 patients between November 2002 and May 2009 and followed them until July 2010 or death. Patients included were also enrolled within the Integrated CKD Care Program for Delaying Dialysis in a medical center and its branch hospital. Demographic, clinical, laboratory, and disease variables at baseline and end of observation were measured.
  
  
  RESULTS
  In diabetic CKD patients, the hazard ratio (HR) at SBP 96-110mm Hg vs. 111-120mm Hg was 2.52 (95% confidence interval (CI) = 1.13-5.58) for cardiovascular outcomes and was 3.14 (95% CI = 1.16-8.49) for renal outcomes. In nondiabetic CKD patients, this J-shaped relationship was not seen. Heavy proteinuria was further found to modify the J-shaped relationship in diabetic CKD patients. The HR for renal outcomes at SBP 96-110mm Hg vs. 111-120mm Hg was 4.07 (95% CI = 1.18-13.99) in diabetic CKD patients with heavy proteinuria vs. 1.72 (95% CI = 0.13-22.5) in those without heavy proteinuria.
  
  
  CONCLUSIONS
  Diabetic CKD patients have a J-shaped relationship between SBP and cardiovascular or renal outcomes, but nondiabetic CKD patients do not. The optimal SBP range might be narrower in the diabetic CKD patients.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Jiannren Hospital, Kaohsiung, Taiwan;
authors.forename: Heng-Pin
authors.initials: HP
authors.lastname: Chiang
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan;
authors.forename: Jia-Jung
authors.initials: JJ
authors.lastname: Lee
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Yi-Wen
authors.initials: YW
authors.lastname: Chiu
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Jer-Chia
authors.initials: JC
authors.lastname: Tsai
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; chichi@cc.kmu.edu.tw.
authors.forename: Chi-Chih
authors.initials: CC
authors.lastname: Hung
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Shang-Jyh
authors.initials: SJ
authors.lastname: Hwang
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Hung-Chun
authors.initials: HC
authors.lastname: Chen
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D018450:Disease Progression; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D012307:Risk Factors; D012720:Severity of Illness Index; D013599:Systole; D013624:Taiwan; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents
keywords: J-shaped relationship; blood pressure; chronic kidney disease; hypertension; outcome assessment; systolic blood pressure.
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