title: Association of BP with Death, Cardiovascular Events, and Progression to Chronic Dialysis in Patients with Advanced Kidney Disease.
abstract: OBJECTIVE
  The optimal BP target to reduce adverse clinical outcomes in patients with CKD is unclear. This study examined the relationship between BP and death, cardiovascular events (CVEs), and kidney disease progression in patients with advanced kidney disease.
  
  
  METHODS
  The relationship of systolic BP (SBP), diastolic BP (DBP), and pulse pressure (PP) with death, CVE, and progression to long-term dialysis was examined in 1099 patients with advanced CKD (eGFR≤30 ml/min per 1.7 3m(2); not receiving dialysis) who participated in the Homocysteine in Kidney and ESRD study. That study enrolled participants from 2001 to 2003. Cox proportional hazard models were used to examine the association between BP and adverse outcomes.
  
  
  RESULTS
  The mean±SD baseline eGFR was 18±7 ml/min per 1.73 m(2). During a median follow-up of 2.9 years, 453 patients died, 215 had a CVE, and 615 initiated long-term dialysis. After adjustment for demographic characteristics and confounders, SBP, DBP, and PP were not associated with a higher risk of death. SBP and DBP were also not associated with CVE. The highest quartile of PP was associated with a substantial higher risk of CVE compared with the lowest quartile (hazard ratio [HR], 1.67; 95% confidence interval [95% CI], 1.10 to 2.52). The highest quartiles of SBP (HR, 1.28; 95% CI, 1.01 to 1.61) and DBP (HR, 1.36; 95% CI, 1.07 to 1.73), but not PP, were associated with a higher risk of progression to long-term dialysis compared with the lowest quartile.
  
  
  CONCLUSIONS
  In patients with advanced kidney disease not undergoing dialysis, higher PP was strongly associated with CVE whereas higher SBP and DBP were associated with progression to long-term dialysis. These results suggest that SBP and DBP should not be the only factors considered in determining antihypertensive therapy; elevated PP should also be considered.
authors.affiliation: Division of Renal Diseases and Hypertension, University of Colorado School of Medicine, Aurora, Colorado;
authors.forename: Shyamal
authors.initials: S
authors.lastname: Palit
authors.affiliation: Division of Renal Diseases and Hypertension, University of Colorado School of Medicine, Aurora, Colorado;
authors.forename: Michel
authors.initials: M
authors.lastname: Chonchol
authors.affiliation: Division of Nephrology & Hypertension, University of Utah, Salt Lake City, Utah; Renal Section, Medical Service, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah; and.
authors.forename: Alfred K
authors.initials: AK
authors.lastname: Cheung
authors.affiliation: Research Service, Veterans Affairs New York Harbor Healthcare System and Department of Medicine, New York University School of Medicine, New York, New York.
authors.forename: James
authors.initials: J
authors.lastname: Kaufman
authors.affiliation: Division of Renal Diseases and Hypertension, University of Colorado School of Medicine, Aurora, Colorado;
authors.forename: Gerard
authors.initials: G
authors.lastname: Smits
authors.affiliation: Division of Renal Diseases and Hypertension, University of Colorado School of Medicine, Aurora, Colorado; Jessica.Kendrick@ucdenver.edu.
authors.forename: Jessica
authors.initials: J
authors.lastname: Kendrick
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D018450:Disease Progression; D004311:Double-Blind Method; D005919:Glomerular Filtration Rate; D007668:Kidney / Q000503:physiopathology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D000959:Antihypertensive Agents
keywords: blood pressure; cardiovascular disease; chronic kidney disease