• Csaba P Kovesdy, Anthony J Bleyer, Miklos Z Molnar, Jennie Z Ma, John J Sim, William C Cushman, L Darryl Quarles, and Kamyar Kalantar-Zadeh.
• Ann. Intern. Med. 2013 Aug 20;159(4):233-42.

BackgroundThe ideal blood pressure (BP) to decrease mortality rates in patients with non-dialysis-dependent chronic kidney disease (CKD) is unclear.ObjectiveTo 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.DesignHistorical cohort between 2005 and 2012.SettingAll U.S. Department of Veterans Affairs health care facilities.Patients651 749 U.S. veterans with CKD.MeasurementsAll 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.ResultsPatients 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.LimitationMostly male patients, inability to establish causality, and large number of patients missing proteinuria measurement.ConclusionThe 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 SourceNational Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, and U.S. Department of Veterans Affairs.

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