Higher systolic blood pressure — the first number, which measures the pressure in blood vessels when the heart beats — is associated with poorer outcomes in patients with kidney disease and a higher risk for a number of conditions, including coronary heart disease, stroke and kidney failure.
However, researchers observed that the association diminishes with age, suggesting a more cautious blood pressure-lowering strategy for elderly patients with chronic kidney disease (CKD).
The research paper, titled “Age and Outcomes Associated with BP in Patients with Incident CKD,” was published in Clinical Journal of the American Society of Nephrology.
Hypertension is the most important treatable risk factor for cardiovascular disease and is especially common in CKD patients. Despite the high incidence of hypertension among these patients and older people, these are the least studied groups in trials evaluating the health effects of lowering blood pressure and studies evaluating the accurate role of blood pressure in older CKD patients.
Researchers led by Dr. Csaba Kovesdy, M.D., from the Memphis VA Medical Center and the University of Tennessee Health Science Center, conducted an investigation of the national VA research database and looked for associations between blood pressure and clinical outcomes in more than 300,000 patients with CKD.
Findings from the examination of patient records include associations between a systolic blood pressure above 140 mmHg and higher risks of coronary heart disease, stroke, kidney failure, and death in patients with CKD of all ages. The association was found to decrease with more advanced age. Systolic blood pressure lower than 110 mmHg was associated with a higher risk of death, but lower risks of coronary heart disease and stroke. And, diastolic blood pressure (which measures the pressure in blood vessels when the heart rests between beats) below 70 mmHg was associated with a higher risk of death, but no other clinical outcomes.
“Ideally, future studies may continue to expand our knowledge … with more detailed exploration of the potential modifying effect of comorbidity and frailty on the association between blood pressure and outcomes in older adults,” Dr. Jessica Weiss, M.D., MCR, wrote in an accompanying editorial, according to a news release. “For now, a tailored application of available data to the constellation of comorbidities and healthcare priorities of a particular patient remains the best approach for individualized hypertension management among older adults with CKD.”
According to researchers, these findings support existing clinical guidelines, but call for a more cautious course of treatment in elderly kidney disease patients.