title: Time-updated systolic blood pressure and the progression of chronic kidney disease: a cohort study.
abstract: BACKGROUND
  Previous reports of the longitudinal association between achieved blood pressure (BP) and end-stage renal disease (ESRD) among patients with chronic kidney disease (CKD) have not incorporated time-updated BP with appropriate covariate adjustment.
  
  
  OBJECTIVE
  To assess the association between baseline and time-updated systolic blood pressure (SBP) with CKD progression.
  
  
  METHODS
  Observational, prospective cohort study. (ClinicalTrials.gov: NCT00304148).
  
  
  METHODS
  7 U.S. clinical centers.
  
  
  METHODS
  Patients in the Chronic Renal Insufficiency Cohort Study (n = 3708) followed for a median of 5.7 years (25th to 75th percentile, 4.6 to 6.7 years).
  
  
  METHODS
  The mean of 3 seated SBP measurements made up the visit-specific SBP. Time-updated SBP was the mean of that and all previous visits. Outcomes were ESRD and the composite end point of ESRD or halving of the estimated glomerular filtration rate. Analyses investigating baseline and time-updated SBP used Cox proportional hazards models and marginal structural models, respectively.
  
  
  RESULTS
  Systolic blood pressure was 130 mm Hg or greater at all visits in 19.2% of patients. The hazard ratio for ESRD among patients with SBP of 130 to 139 mm Hg, compared with SBP less than 120 mm Hg, was 1.46 (95% CI, 1.13 to 1.88) using only baseline data and 2.37 (CI, 1.48 to 3.80) using time-updated data. Among patients with SBP of 140 mm Hg or greater, corresponding hazard ratios were 1.46 (CI, 1.18 to 1.88) and 3.37 (CI, 2.26 to 5.03) for models using only baseline data and those using time-updated data, respectively.
  
  
  CONCLUSIONS
  Blood pressure was measured once annually, and the cohort was not a random sample.
  
  
  CONCLUSIONS
  Time-updated SBP greater than 130 mm Hg was more strongly associated with CKD progression than analyses based on baseline SBP.
  
  
  BACKGROUND
  National Institute of Diabetes and Digestive and Kidney Diseases.
authors: Amanda H
authors: AH
authors: Anderson
authors: Wei
authors: W
authors: Yang
authors: Raymond R
authors: RR
authors: Townsend
authors: Qiang
authors: Q
authors: Pan
authors: Glenn M
authors: GM
authors: Chertow
authors: John W
authors: JW
authors: Kusek
authors: Jeanne
authors: J
authors: Charleston
authors: Jiang
authors: J
authors: He
authors: RadhaKrishna
authors: R
authors: Kallem
authors: James P
authors: JP
authors: Lash
authors: Edgar R
authors: ER
authors: Miller
authors: Mahboob
authors: M
authors: Rahman
authors: Susan
authors: S
authors: Steigerwalt
authors: Matthew
authors: M
authors: Weir
authors: Jackson T
authors: JT
authors: Wright
authors: Harold I
authors: HI
authors: Feldman
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D007676:Kidney Failure, Chronic / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000503:physiopathology*; D013997:Time Factors; D055815:Young Adult
chemical_list: D000959:Antihypertensive Agents