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Association of blood pressure with cardiovascular outcome and mortality: results from the KNOW-CKD study

Authors
 Jee Young Lee  ;  Jung Tak Park  ;  Young Su Joo  ;  Changhyun Lee  ;  Hae-Ryong Yun  ;  Tae Ik Chang  ;  Yeong-Hoon Kim  ;  WooKyung Chung  ;  Tae-Hyun Yoo  ;  Shin-Wook Kang  ;  Sue K Park  ;  Dong Wan Chae  ;  Kook-Hwan Oh  ;  Seung Hyeok Han 
Citation
 NEPHROLOGY DIALYSIS TRANSPLANTATION, Vol.37(9) : 1,722-1,730, 2022-08 
Journal Title
NEPHROLOGY DIALYSIS TRANSPLANTATION
ISSN
 0931-0509 
Issue Date
2022-08
MeSH
Blood Pressure ; Cardiovascular Diseases* / complications ; Cardiovascular Diseases* / etiology ; Cohort Studies ; Humans ; Hypertension* ; Renal Insufficiency, Chronic* ; Risk Factors
Keywords
CKD ; SBP ; cardiovascular outcome ; hypertension ; mortality
Abstract
Background: Optimal blood pressure (BP) control is a major therapeutic strategy to reduce adverse cardiovascular events (CVEs) and mortality in patients with chronic kidney disease (CKD). We studied the association of BP with adverse cardiovascular outcome and all-cause death in patients with CKD.

Methods: Among 2238 participants from the KoreaN cohort study for Outcome in patients With CKD (KNOW-CKD), 2226 patients with baseline BP measurements were enrolled. The main predictor was systolic BP (SBP) categorized by five levels: <110, 110-119, 120-129, 130-139 and ≥140 mmHg. The primary endpoint was a composite outcome of all-cause death or incident CVEs. We primarily used marginal structural models (MSMs) using averaged and the most recent time-updated SBPs.

Results: During the follow-up of 10 233.79 person-years (median 4.60 years), the primary composite outcome occurred in 240 (10.8%) participants, with a corresponding incidence rate of 23.5 [95% confidence interval (CI) 20.7-26.6]/1000 patient-years. MSMs with averaged SBP showed a U-shaped relationship with the primary outcome. Compared with time-updated SBP of 110-119 mmHg, hazard ratios (95% CI) for <110, 120-129, 130-139 and ≥140 mmHg were 2.47 (1.48-4.11), 1.29 (0.80-2.08), 2.15 (1.26-3.69) and 2.19 (1.19-4.01), respectively. MSMs with the most recent SBP also showed similar findings.

Conclusions: In Korean patients with CKD, there was a U-shaped association of SBP with the risk of adverse clinical outcomes. Our findings highlight the importance of BP control and suggest a potential hazard of SBP <110 mmHg.
Full Text
https://academic.oup.com/ndt/article/37/9/1722/6362901?login=true
DOI
10.1093/ndt/gfab257
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Shin Wook(강신욱) ORCID logo https://orcid.org/0000-0002-5677-4756
Park, Jung Tak(박정탁) ORCID logo https://orcid.org/0000-0002-2325-8982
Yoo, Tae Hyun(유태현) ORCID logo https://orcid.org/0000-0002-9183-4507
Yun, Hae Ryong(윤해룡) ORCID logo https://orcid.org/0000-0002-7038-0251
Joo, Young Su(주영수) ORCID logo https://orcid.org/0000-0002-7890-0928
Han, Seung Hyeok(한승혁) ORCID logo https://orcid.org/0000-0001-7923-5635
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/191881
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