Older persons with chronic kidney disease and lower systolic blood pressure have higher mortality rates
Research Activities, June 2011, No. 370
Chronic kidney disease (CKD) guidelines recommend a blood pressure target of less than 130/80 mm Hg for all patients. Since these guidelines are age-neutral, the potential benefits of reducing blood pressure to that level in older patients with CKD are unclear. However, a new study finds that the mortality rates for CKD patients over age 75 with systolic blood pressure (SBP) under 130 mm Hg are higher than those whose SBP is between 130 and 160. This finding is unexplained by conventional knowledge and raises new questions regarding the appropriateness of current CKD hypertension guidelines in the elderly. The study also found that mortality rates for older patients with CKD are higher if their SBP is greater than 160. Both of these groups had higher rates of cardiovascular hospitalization.
CKD, the slow loss of kidney function over time, is especially common among older adults; 37 percent of those over 65 and 50 percent of those over 85 are estimated to have CKD. The researchers included 3,099 community-dwelling adults aged 75 and over with stages 3-5 CKD in their study, which tracked their SBP, mortality rates, and cardiac hospitalization rates for a 5-year period. Since the study was retrospective, causation could not be inferred.
The researchers suggest that aggressive anti-hypertensive management may not be without risk for older patients with CKD. This study was supported in part by the Agency for Healthcare Research and Quality (HS17582).
See "Systolic blood pressure and mortality among older community-dwelling adults with CKD," by Jessica W. Weiss, M.D., Eric S. Johnson, Ph.D., Amanda Petrik, M.S., and others in the December 2010 American Journal of Kidney Diseases 56(6), pp. 1062-1071.