Blood Pressure and Cardiovascular Outcomes in Adults With Diabetes and Chronic Kidney Disease

Abstract

BACKGROUND: Current hypertension guidelines recommend intensive blood pressure (BP) targets (eg, <130/80mmHg) for patients with diabetes and chronic kidney disease. However, data supporting these recommendations are limited. METHODS: From Korean nationwide health screening and claims data, we identified 373 966 adults with both diabetes and chronic kidney disease who (1) underwent a baseline health examination in 2009 to 2013; (2) had >= 3 BP-measuring visits during a 5-year look-back period; and (3) did not have prior cardiovascular disease (CVD). The mean of all BPs measured throughout the look-back period was used for the analysis. The primary outcome was CVD event, defined as a composite of myocardial infarction, stroke, heart failure, or death from CVD. RESULTS: Over a median follow-up of 10.2years, 40 781 CVD events occurred. When using systolic BP 130 to <140mmHg as the reference, multivariable-adjusted hazard ratios (HRs) for CVD event in the systolic BP >= 150, 140 to <150, 120 to <130, and <120 mm Hg groups were 1.34 (95% CI, 1.29-1.39), 1.11 (95% CI, 1.08-1.14), 0.89 (95% CI, 0.87-0.91), and 0.77 (95% CI, 0.74-0.80), respectively. When using diastolic BP 80 to <90 mm Hg as the reference, HRs in the diastolic BP >= 100, 90 to <100, 70 to <80, and <70 mm Hg groups were 1.70 (95% CI, 1.56-1.85), 1.19 (95% CI, 1.15-1.24), 0.88 (95% CI, 0.86-0.90), and 0.83 (95% CI, 0.80-0.87), respectively. Systolic BP <130mmHg and diastolic BP <80mmHg were each associated with reduced CVD risk in a log-linear pattern. CONCLUSIONS: Among patients with diabetes and chronic kidney disease, SBP <130 mm Hg and diastolic BP <80 mm Hg were associated with reduced risk of CVD.