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Low blood pressure 'linked with mortality' in CKD

Low blood pressure is associated with higher all-cause mortality rates in patients with chronic kidney disease, suggests new research.

 

The study

US researchers looked at the association of blood pressure with death in patients with chronic kidney disease. Some 651,749 veterans (mean age 73.8 years) with chronic kidney disease participated in the study, and all possible combinations of systolic blood pressure (SBP) and diastolic blood pressure (DBP) were examined from lowest (<80/<40mmHg) to highest (>210/>120mmHg), in 10mmHg increments. Patients in the reference group of the study had a SBP of 120-139mmHg or a DBP of 80-89mmHg.

The results

Patients with SBP <120mmHg and DBP <80mmHg were 62% more likely to die, compared with the reference group. This compared with unadjusted hazard ratios of 0.94 for mortality in patients with a SBP of 140-159mmHg, and 0.94 in patients with a DBP of 90-99mmHg , compared with the reference group. Patients with a SBP of ≥160mmHg or DBP of ≥100mmHg had a HR of 1.08.

What this means for GPs

The researchers concluded that ‘low BP should be regarded as potentially deleterious in this patient population, and we suggest caution in lowering BP to less than what has been demonstrated as beneficial in randomised, controlled trials’.

Ann Intern Med 2013, online 19 Aug

 

Readers' comments (2)

  • Does that mean I can take all the old people off ACEs for the CKD3 that they most likeyy dont have anyway?

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  • Ivan Benett

    We have known fo a long time that too low BP has worse outcomes in CKD. That's why we named a BP range in the 2008 NICE guideline on CKD. As for stopping ACEI in the elderly, there is no evidence for them anyway unless they have significant proteinuria. So yes 'anonymous' you can take the 'old people' off ACEI if they don't have proteinuria. Most older people simply have aging kidneys and will not benefit from ACEI, but will from BP control within the stated range
    ivan.benett@nhs.net.
    Remember if they DO have proteinuria, they are at increased risk of CVD outcomes, so consider statins

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