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Cited by 213Blood Pressure and Hypertension StudiesChronic Kidney Disease and DiabetesDialysis and Renal Disease Management

Blood Pressure and Mortality in U.S. Veterans With Chronic Kidney Disease: A Cohort Study

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Kovesdy, Csaba P., Bleyer, Anthony J., Molnar, Miklos Z., Ma, Jennie Z., Sim, John J., Cushman, William C., Quarles, L. Darryl, Kalantar-Zadeh, Kamyar·2013·Annals of Internal Medicine
DOI 10.7326/0003-4819-159-4-201308200-00004PMC PMC4155539
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Abstract

BACKGROUND: The ideal blood pressure (BP) to decrease mortality rates in patients with non-dialysis-dependent chronic kidney disease (CKD) is unclear. OBJECTIVE: To assess the association of BP (defined as the combination of systolic BP [SBP] and diastolic BP [DBP] at the individual level) with death in patients with CKD. DESIGN: Historical cohort between 2005 and 2012. SETTING: All U.S. Department of Veterans Affairs health care facilities. PATIENTS: 651 749 U.S. veterans with CKD. MEASUREMENTS: All possible combinations of SBP and DBP were examined in 96 categories from lowest (<80/<40 mm Hg) to highest (>210/>120 mm Hg), in 10-mm Hg increments. Associations with all-cause mortality were examined in time-dependent Cox models with adjustment for relevant confounders. RESULTS: Patients with SBP of 130 to 159 mm Hg combined with DBP of 70 to 89 mm Hg had the lowest adjusted mortality rates, and those in whom both SBP and DBP were concomitantly very high or very low had the highest mortality rates. Patients with moderately elevated SBP combined with DBP no less than 70 mm Hg had consistently lower mortality rates than did patients with ideal SBP combined with DBP less than 70 mm Hg. Results were consistent in subgroups of patients with normal and elevated urinary microalbumin-creatinine ratios. LIMITATION: Mostly male patients, inability to establish causality, and large number of patients missing proteinuria measurement. CONCLUSION: The optimal BP in patients with CKD seems to be 130 to 159/70 to 89 mm Hg. It may not be advantageous to achieve ideal SBP at the expense of lower-than-ideal DBP in adults with CKD. PRIMARY FUNDING SOURCE: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, and U.S. Department of Veterans Affairs.

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  • In an observational study of male veterans, there was a beneficial effect of lowering SBP, but only if diastolic blood pressure was not <70 mmHg.

    “In an observational study of male veterans there was a beneficial effect of lowering SBP, but only if diastolic blood pressure was not <70 mmHg (86).”

    From 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [86]

    The Results (Mortality) and Discussion report that lower SBP/DBP combinations were associated with lower mortality only when DBP remained above approximately 70 mmHg. But the study examined veterans with chronic kidney disease and reports an observational association, not a demonstrated beneficial effect of lowering SBP; the Discussion says trials are needed to establish treatment targets. (LLM, conf=0.88)

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Authors
Kovesdy, C. P., Bleyer, A. J., Molnar, M. Z., Ma, J. Z., Sim, J. J., Cushman, W. C., Quarles, L. D., & Kalantar-Zadeh, K.
Affiliations
  • Semmelweis University (HU)
  • From Memphis Veterans Affairs Medical Center and University of Tennessee Health Science Center, Memphis, Tennessee; Wake Forest School of Medicine, Winston-Salem, North Carolina; University Health Network, University of Toronto, Toronto, Ontario, Canada; Semmelweis University, Budapest, Hungary; University of Virginia, Charlottesville, Virginia; Kaiser Permanente Los Angeles Medical Center, Los Angeles, California; and University of California, Irvine, Orange, California.
ORCID
Venue
Annals of Internal Medicine
Publisher
American College of Physicians
Published
2013-08-20
Volume
159
Issue
4
Pages
233-242
ISSN
  • 0003-4819 (ISSN-L)
  • 1539-3704
DOI
10.7326/0003-4819-159-4-201308200-00004
PMC
PMC4155539
OpenAlex
W2119470206
Cited by
213
References
4
Citations by year
2026: 6 · 2025: 4 · 2024: 5 · 2023: 10 · 2022: 11 · 2021: 8 · 2020: 14 · 2019: 21 · 2018: 19 · 2017: 27 · 2016: 28 · 2015: 25 · 2014: 26 · 2013: 8
FWCI
19.73
Type
journal article
Language
en
Open access
Licence
www.acpjournals.org/journal/aim/text-and-data-mining (tdm)
Locations
  • Annals of Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion, cc-by)
Funders
  • U.S. Department of Veterans Affairs (1R01DK078106-01)
  • National Institute of Diabetes and Digestive and Kidney Diseases (R01DK078106)
  • National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01AR045955)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
  • Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
  • Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
Keywords
chronic kidney disease, blood pressure, all-cause mortality, systolic blood pressure, diastolic blood pressure, veterans, urinary albumin-creatinine ratio, proteinuria, blood pressure targets
MeSH terms
Aged, Antihypertensive Agents, Blood Pressure, Cause of Death, Female, Glomerular Filtration Rate, Humans, Hypertension, Male, Middle Aged, Risk Factors, United States, Comorbidity, Proportional Hazards Models, Renal Insufficiency, Chronic

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