• Amanda H Anderson, Wei Yang, Raymond R Townsend, Qiang Pan, Glenn M Chertow, John W Kusek, Jeanne Charleston, Jiang He, RadhaKrishna Kallem, James P Lash, Edgar R Miller, Mahboob Rahman, Susan Steigerwalt, Matthew Weir, Jackson T Wright, Harold I Feldman, and Chronic Renal Insufficiency Cohort Study Investigators.
• Ann. Intern. Med. 2015 Feb 17; 162 (4): 258265258-65.

BackgroundPrevious 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.ObjectiveTo assess the association between baseline and time-updated systolic blood pressure (SBP) with CKD progression.DesignObservational, prospective cohort study. (ClinicalTrials.gov: NCT00304148).Setting7 U.S. clinical centers.PatientsPatients 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).MeasurementsThe 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.ResultsSystolic 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.LimitationBlood pressure was measured once annually, and the cohort was not a random sample.ConclusionTime-updated SBP greater than 130 mm Hg was more strongly associated with CKD progression than analyses based on baseline SBP.Primary Funding SourceNational Institute of Diabetes and Digestive and Kidney Diseases.

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