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Cardiovascular Implications of the 2021 KDIGO Blood Pressure Guideline for Adults With Chronic Kidney Disease

Authors
 Hyeok-Hee Lee  ;  Hokyou Lee  ;  Raymond R Townsend  ;  Dong-Wook Kim  ;  Sungha Park  ;  Hyeon Chang Kim 
Citation
 JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, Vol.79(17) : 1675-1686, 2022-05 
Journal Title
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
ISSN
 0735-1097 
Issue Date
2022-05
MeSH
Adult ; Blood Pressure ; Cross-Sectional Studies ; Female ; Humans ; Hypertension* / complications ; Hypertension* / epidemiology ; Hypertension* / therapy ; Male ; Nutrition Surveys ; Renal Insufficiency, Chronic* / complications ; Renal Insufficiency, Chronic* / epidemiology ; Renal Insufficiency, Chronic* / therapy ; United States / epidemiology
Keywords
blood pressure target ; cardiovascular outcome ; chronic kidney disease ; guideline ; nondialysis
Abstract
Background: The 2021 Kidney Disease: Improving Global Outcomes (KDIGO) guideline recommends a systolic blood pressure (BP) target of <120 mm Hg for nondialysis chronic kidney disease (CKD).

Objectives: We sought to examine the potential implications of the 2021 KDIGO BP target, compared with the 2012 KDIGO and 2017 American College of Cardiology (ACC)/American Heart Association (AHA) BP targets, as related to cardiovascular disease (CVD) outcomes.

Methods: From the cross-sectional Korea National Health and Nutrition Examination Survey (KNHANES) and longitudinal National Health Insurance Service (NHIS) data, adults with nondialysis CKD were identified and categorized into 4 groups based on concordance/discordance between guidelines: 1) above both targets; 2) above 2021 KDIGO only; 3) above 2012 KDIGO or 2017 ACC/AHA only; and 4) controlled within both targets. We determined the nationally representative proportion and CVD risk of each group.

Results: In KNHANES (n = 1,939), 50.2% had BP above both 2021 and 2012 KDIGO targets, 15.9% above the 2021 KDIGO target only, 3.5% above the 2012 KDIGO target only, and 30.4% controlled within both targets. In NHIS (n = 412,167; median follow-up: 10.0 years), multivariable-adjusted HRs for CVD events were 1.52 (95% CI: 1.47-1.58) among participants with BP above both targets, 1.28 (95% CI: 1.24-1.32) among those with BP above 2021 KDIGO only, and 1.07 (95% CI: 0.61-1.89) among those with BP above 2012 KDIGO only, compared to those with BP controlled within both targets. Results were similar for comparison between 2021 KDIGO and 2017 ACC/AHA BP targets.

Conclusions: New candidates for BP-lowering treatment per the 2021 KDIGO guideline account for a substantial proportion of the total CKD population and bear significantly high CVD risk.
Full Text
https://www.sciencedirect.com/science/article/pii/S0735109722005599?via%3Dihub.
DOI
10.1016/j.jacc.2022.02.040
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Preventive Medicine (예방의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Hyeon Chang(김현창) ORCID logo https://orcid.org/0000-0001-7867-1240
Park, Sung Ha(박성하) ORCID logo https://orcid.org/0000-0001-5362-478X
Lee, Hyeok-Hee(이혁희)
Lee, Hokyou(이호규) ORCID logo https://orcid.org/0000-0002-5034-8422
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/189369
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