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Abstract: PO1790

Cardiovascular and Renal Outcomes of the New Intensive Blood Pressure Target in a CKD Population in Korea

Session Information

Category: Hypertension and CVD

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

Authors

  • Jeong, Kyung hwan, Kyung Hee University Medical Center, Seoul, Korea (the Republic of)
  • Yoon, Soo-Young, Kyung Hee University Medical Center, Seoul, Korea (the Republic of)
  • Kong, Ji Yoon, Kyung Hee University, Seoul, Korea (the Republic of)
  • Kim, Dae Kyu, Kyung Hee University Medical Center, Seoul, Korea (the Republic of)
  • Kim, Jongho, Kyung Hee University Medical Center, Seoul, Korea (the Republic of)
  • Kang, Shinyeong, Kyung Hee University Medical Center, Seoul, Korea (the Republic of)
  • Kim, Jin sug, Kyung Hee University Medical Center, Seoul, Korea (the Republic of)
  • Hwang, Hyeon Seok, Kyung Hee University Medical Center, Seoul, Korea (the Republic of)
Background

Hypertension is one of the most important modifiable risk factors of cardiovascular disease (CVD) including ischemic heart disease (IHD) and stroke. The 2021 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for the Management of Blood Pressure (BP) in CKD recommended a target systolic BP (SBP) <120 mmHg regardless of albuminuria, using standardized office BP measurement. We evaluated the prevalence of cardiovascular events and CKD progression to assess the effects of this intensive BP target for CKD patients in Korea.

Methods

The data of 166,397 adults whose baseline estimated glomerular filtration rate (eGFR) <60 mL/min per 1.73 m2 were extracted from the Korean National Health Insurance Service database between 2009 and 2011. The data were adjusted for multiple factors such as age, sex, smoking, eGFR, and anti-hypertensive medications in multivariate Cox proportional hazards regression models. All participants were divided into four SBP categories (<120 mmHg, 120-129 mmHg, 130-139 mmHg, ≥140 mmHg). The primary outcome was CVD risk, and the secondary outcome was the risk of progression to end-stage renal disease (ESRD), especially in need of intermittent hemodialysis (HD).

Results

The mean ages of the each group of CKD patients were 45.1±15.71 years in SBP <120 mmHg group and 52.13±16.00 years in SBP 120-129 mmHg group. 11.1% in SBP <120 mmHg group and 24.6% in SBP 120-129 mmHg group of the participants were already taking anti-hypertensive medications. 112,012 patients (67.3%) had SBP ≥120 mmHg, and 78,119 patients (46.9%) had SBP ≥130 mmHg. Participants with SBP 120-129 mmHg exhibited a significantly high risk for IHD (hazard ratio (HR), 1.29; 95% confidence interval (CI), 1.03-1.61; P = 0.03) and stroke (HR, 1.57; 95% CI, 1.13-2.18; P <0.001) when compared with the participants with SBP <120 mmHg. Also, the risk of progression to ESRD was also higher (HR, 1.67; 95% CI, 1.46-1.91; P <0.001). Similar statistical findings were observed between the group with SBP <120mmHg and the other groups.

Conclusion

Therefore, the new intensive BP target can be applied to the real clinical practice in CKD population with proper BP monitoring in Korea, and it may eventually reduce the risk of CVD and progression to ESRD in a number of CKD outpatients.