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Abstract: FR-PO1014

Association of Systolic Blood Pressure with Cardiovascular and Renal Outcomes in CKD: A Nationwide Cohort Study

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Kang, Shin-Wook, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Korea (the Republic of)
  • Jung, Chan-Young, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Korea (the Republic of)
  • Ko, Byounghwi, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Korea (the Republic of)
  • Jo, Wonji, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Korea (the Republic of)
  • Chang, Tae ik, National Health Insurance Service Medical Center, Ilsan Hospital, Gyunggi-do, Korea (the Republic of)
Background

Blood pressure (BP) is associated with a linearly incremental risk for cardiovascular disease and death in the general population. However, the ideal BP to decrease cardiovascular and renal risk in patients with non-dialysis-dependent chronic kidney disease (CKD) is unclear.

Methods

We studied the associations of baseline systolic BP (SBP) with the risk of composite outcomes (all-cause death, acute myocardial infarction, heart failure, stroke, and end-stage renal disease) in 1.5 million adults who participated in the NHIS National Health Checkup Program between 2009 and 2012 and had an estimated glomerular filtration rate (eGFR) 15−59 mL/min/1.73m2 at study entry using Cox proportional hazard models.

Results

During 8,223,922 person-years of follow-up, the composite outcomes occurred in 305,851 (20.5%) subjects with a crude event rate of 37.2 (95% CI, 37.1-37.3) per 1,000 person-years. In fully-adjusted Cox models, there was a U-shaped association between SBP and composite outcomes, such that SBP <120 mmHg and SBP ≥130 mmHg were each associated with higher risk of cardiovascular and renal outcomes (reference: 120-129 mmHg): the HRs (95% CIs) were 1.20 (1.18-1.22), 1.08 (1.07-1.09), 1.03 (1.02-1.04), and 1.10 (1.09-1.11) for SBP <110, 110-119, 130-139, and ≥140 mmHg, respectively. These associations remained consistent and significant across all eGFR strata.

Conclusion

In a large national cohort of Korean adult population with CKD, the association of SBP levels with cardiovascular and renal risks was U-shaped, with both lower and higher SBP levels showing a substantial and significant increase in death, major cardiovascular events, and end-stage renal disease.