Clinical outcomes with a systolic blood pressure lower than 120 mmHg in older patients with high disease burden.
BACKGROUND
The target blood pressure in older patients is controversial. Recent studies provided clinical evidence supporting a target systolic blood pressure <120 mmHg in patients >50 years at high risk of cardiovascular events.


METHODS
Retrospective study of 380 consecutive patients ≥60 years with stages 1-5 pre-dialysis chronic kidney disease seen between January 2013 and November 2015. The outcomes of a systolic blood pressure <120 mmHg in older patients with chronic kidney disease and multiple comorbidities were analyzed.


RESULTS
Sixty-eight patients had a systolic blood pressure <120 mmHg, 312 patients had a systolic blood pressure ≥120 mmHg. Forty-three patients died during the follow up (11.3%). Patients with a systolic blood pressure <120 mmHg had a higher risk of death: 21 (30.9%) vs 22 (7%). Primary cause of death: Cardiovascular: 11 (25.6%), infectious 9 (20.9%), cancer 5 (11.6%), renal failure 6 (13.9%), COPD/pulmonary fibrosis 2 (4.6%), end stage liver disease 3 (6.9%), traumatic brain injury 1 (2.3%), gastrointestinal hemorrhage 4 (9.3%), complications of diabetes 1 (2.3%), unknown 1 (2.3%). After adjusting for confounding factors, a systolic blood pressure <120 mmHg remained associated with increased mortality. There was a trend to more cardiovascular outcomes in those with a lower blood pressure.


CONCLUSIONS
A systolic blood pressure below 120 mmHg in older patients with high disease burden was associated with adverse outcomes. Individualization of blood pressure therapy to each specific patient is warranted.
a Nephrology Department , Affiliated Community Medical Centers, Rice Memorial Hospital , Willmar , MN , USA.
Carlos R
CR
Franco Palacios
a Nephrology Department , Affiliated Community Medical Centers, Rice Memorial Hospital , Willmar , MN , USA.
Eric N
EN
Haugen
b Pharmacy Department , Rice Memorial Hospital , Willmar , MN , USA.
Amanda M
AM
Thompson
a Nephrology Department , Affiliated Community Medical Centers, Rice Memorial Hospital , Willmar , MN , USA.
Richard W
RW
Rasmussen
b Pharmacy Department , Rice Memorial Hospital , Willmar , MN , USA.
Nathan
N
Goracke
c Hospital Medicine Department , Affiliated Community Medical Centers, Rice Memorial Hospital , Willmar , MN , USA.
Pankaj
P
Goyal
D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D002423:Cause of Death / Q000639:trends; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology
Hypertension; cardiovascular disease; chronic kidney disease; elderly; outcomes