Abstract: FR-PO105
Time to Blood Pressure Control and Blood Pressure Targets Significantly Impact Mortality Among Veterans Following AKI
Session Information
- AKI: Epidemiology, Risk Factors, Prevention - I
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Griffin, Benjamin R., University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
- Sarrazin, Mary Vaughan, University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
- Yamada, Masaaki, University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
- Shi, Qianyi, University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
- Sambharia, Meenakshi, University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
- Swee, Melissa L., University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
- Jalal, Diana I., University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
Background
Acute kidney injury (AKI) complicates 20-25% of hospital admissions, and is associated with increased long-term mortality. Effective blood pressure (BP) control following AKI may improve outcomes, but appropriate BP targets and optimal timing of BP medication initiation are unclear.
Methods
This retrospective cohort analysis included adult Veterans admitted from 2013 to 2018 with in-hospital AKI and ≥1 blood pressure measurement within 30 days of discharge. Systolic BP control was treated as time dependent and categorized as <120, 120-129, and 130-139, relative to >140 mm HG. The primary outcome was time to death. Cox Proportional Hazards regression was adjusted for demographics, chronic lung disease, unexplained weight loss, dementia, congestive heart failure (CHF), hematocrit, blood urea nitrogen, bilirubin, and albumin. [YM1] To evaluate the impact of BP control over time, we calculated hazard ratios (HR) at 7 different timepoints (30, 60, 90, 120, 180, 270, and 365 days after discharge).
Results
A total of 97,376 Veterans were included and 14,819 (15%) died within 1 year of discharge. The cohort had high rates of hypertension (85%), CHF (28%), and diabetes mellitus (19%). All BP categories <140 mmHg had significantly reduced HRs for mortality relative to uncontrolled BP, but the 130-139 mmHg group had the lowest HRs (Table). For all BP categories, hazard ratios relative to uncontrolled BP were lowest at the 30-day mark and increased over time (Table).
Conclusion
Among post-AKI Veterans, BP control within 30 days of discharge was associated with reduced mortality, but this benefit was attenuated over time. All BP targets were superior to blood pressure >140 mmHg, but the 130-139 mmHg group had the lowest risk of death at each timepoint. These findings highlight the importance of achieving BP control promptly post-AKI and suggest that targeting a systolic BP of 130-139 is ideal.