Abstract: FR-PO741
Routine Office Blood Pressure and All-Cause Mortality Among US Veterans With CKD
Session Information
- Hypertension and CVD: Clinical, Outcomes, Trials
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1502 Hypertension and CVD: Clinical‚ Outcomes‚ and Trials
Authors
- Yamada, Masaaki, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
- Sambharia, Meenakshi, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
- Griffin, Benjamin R., University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
- Swee, Melissa L., Iowa City VA Medical Center, Iowa City, Iowa, United States
- Reisinger, Heather, Iowa City VA Medical Center, Iowa City, Iowa, United States
- Lund, Brian C., Iowa City VA Medical Center, Iowa City, Iowa, United States
- Jalal, Diana I., Iowa City VA Medical Center, Iowa City, Iowa, United States
Background
Intensive blood pressure control has been shown to reduce the risk of death in individuals at high risk of cardiovascular disease. Data regarding blood pressure control are limited in chronic kidney disease (CKD). Here, we examined the association of different office blood pressure categories with all-cause mortality in a national sample of US Veterans stratified by kidney function
Methods
Veterans with prevalent hypertension (as defined by i. International Classification of Disease-10 codes related to hypertension, ii. prescription of antihypertensive drugs, or iii. ≥2 office BP of ≥130/90 mmHg) who had ≥2 systolic blood pressure (SBP) readings between 2016-2017 with a follow-up through March 2021 were included. Those with mean SBP <100 mmHg were excluded. CKD categories were defined based on estimated glomerular filtration rate (eGFR): <30, 30-60, and >60 mL/min/1.73m2. We examined the association of mean SBP control (3 groups: <120, 120-129, and ≥130 mmHg) with all-cause mortality by using time-dependent Cox regression models adjusted for demographics, body mass index, and comorbid conditions. SBP was modeled as a time-dependent variable
Results
Total 30,782,873 hypertensive Veterans had eGFR available were included in our analyses. Of those, 1.3% (n=394,132) had eGFR <30 mL/min/1.73m2 at baseline; 18.4% (n=5,649,379) had 30-60 mL/min/1.73m2; and 80.4% (n=24,739,362) had >60 mL/min/1.73m2. Mean SBP <120 and 120-129 mmHg categories were associated with reduced mortality compared to ≥130 mmHg (Table 1), although SBP category 120-129 mmHg was associated with the least risk of all-cause mortality (Table 1). These findings were notable in Veterans across all eGFR categories including those with stage 4 CKD
Conclusion
Mean SBP of 120-129 mmHg was indeed associated with lower mortality than <120 mmHg, and both 120-129 and <120 were superior to SBP ≥130 mmHg among all Veterans including advanced CKD
Table 1. Mortality risk
| Kidney function, eGFR (mL/min/1.73m2) | Mean systolic blood pressure (mmHg) | Hazard ratio | 95% confidence interval |
| eGFR <30, n=394,132 (1.3%) | <120 | 0.86 | 0.84-0.89 |
| 120-129 | 0.63 | 0.61-0.66 | |
| ≧130 | 1 (reference) | ||
| eGFR 30-60, n=5,649,379 (18.4%) | <120 | 0.91 | 0.90-0.92 |
| 120-129 | 0.65 | 0.64-0.66 | |
| ≧130 | 1 (reference) | ||
| eGFR >60, n=24,739,362 (80.4%) | <120 | 0.93 | 0.92-0.93 |
| 120-129 | 0.67 | 0.66-0.67 | |
| ≧130 | 1 (reference) |
Funding
- Veterans Affairs Support