scholarly journals Optimal blood pressure for patients with chronic kidney disease: a nationwide population-based cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
You-Bin Lee ◽  
Ji Sung Lee ◽  
So-hyeon Hong ◽  
Jung A. Kim ◽  
Eun Roh ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Cardiovascular Events ◽  
Antihypertensive Treatment ◽  
Antihypertensive Agents ◽  
Population Based ◽  
Adverse Outcomes ◽  
Optimal Blood Pressure ◽  
Stage Renal Disease

AbstractThe effect of blood pressure (BP) on the incident cardiovascular events, progression to end-stage renal disease (ESRD) and mortality were evaluated among chronic kidney disease (CKD) patients with and without antihypertensive treatment. This nationwide study used the Korean National Health Insurance Service-Health Screening Cohort data. The hazards of outcomes were analysed according to the systolic BP (SBP) or diastolic BP (DBP) among adults (aged ≥ 40 years) with CKD and without previous cardiovascular disease or ESRD (n = 22,278). The SBP and DBP were ≥ 130 mmHg and ≥ 80 mmHg in 10,809 (48.52%) and 11,583 (51.99%) participants, respectively. During a median 6.2 years, 1271 cardiovascular events, 201 ESRD incidents, and 1061 deaths were noted. Individuals with SBP ≥ 130 mmHg and DBP ≥ 80 mmHg had higher hazards of hypertension-related adverse outcomes compared to the references (SBP 120–129 mmHg and DBP 70–79 mmHg). SBP < 100 mmHg was associated with hazards of all-cause death, and composite of ESRD and all-cause death during follow-up only among the antihypertensive medication users suggesting that the BP should be < 130/80 mmHg and the SBP should not be < 100 mmHg with antihypertensive agents to prevent the adverse outcome risk of insufficient and excessive antihypertensive treatment in CKD patients.

Feline comorbidities: The intermingled relationship between chronic kidney disease and hypertension

2021 ◽  
Vol 23 (9) ◽  
pp. 812-822
Author(s):  
Jack S Lawson ◽  
Rosanne E Jepson
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Antihypertensive Treatment ◽  
Blood Pressure Monitoring ◽  
Large Body ◽  
Clinical Signs ◽  
Antihypertensive Agents ◽  
Pressure Monitoring ◽  
Consensus Statements

Practical relevance: Chronic kidney disease (CKD) is a highly prevalent disorder of senior cats. CKD is frequently diagnosed in association with hypertension, and the two conditions have an intermingled cause-and-effect relationship. Hypertensive target organ damage (TOD) to the eye, brain, heart and kidney significantly impacts the welfare of cats suffering from this comorbidity. Hypertension also drives proteinuria, which is an independent risk factor for progression and mortality in cats with CKD. Blood pressure monitoring and institution of effective antihypertensive treatment, where indicated, is therefore crucial in effective management of the feline CKD patient. Current guidelines recommend a target systolic blood pressure of <160 mmHg to minimise risk of TOD. Both amlodipine besylate and telmisartan are effective antihypertensive agents for use in these patients. Clinical challenges: Clinical signs of hypertension may not be apparent to owners of affected cats until severe hypertensive TOD is present. Despite this, blood pressure monitoring in cats with CKD is still infrequently performed, and hypertension likely remains underdiagnosed in this population. Evidence base: This review is based upon evaluation of the currently available published literature, including relevant consensus statements. There is a large body of evidence supporting the association between hypertension and CKD in cats. However, significant aspects, such as the mechanisms behind this association, and effect of hypertension and antihypertensive treatment on mortality and progression of CKD, remain unclear. Further research is therefore required in order to improve understanding of these conditions.

scholarly journals Characteristics, Mortality and Cardiovascular Events in Chronic Kidney Disease According To Previous Type 2 Diabetes Mellitus and/or Hypertension. A Population-Based Epidemiological Study (KIDNEES)

2021 ◽  
Author(s):  
Betlem Salvador-González ◽  
Oriol Cunillera-Puértolas ◽  
David Vizcaya ◽  
M Jesus Cerain-Herrero ◽  
Neus Gil-Terrón ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Type 2 Diabetes Mellitus ◽  
Kidney Disease ◽  
Cardiovascular Events ◽  
Population Based ◽  
Adverse Outcomes

Abstract Introduction and objectives. Chronic Kidney Disease (CKD) entails a considerable burden of adverse outcomes. Identifying the cause is recommended but data on its prognostic value are scarce. We aimed to estimate how the clinical, cardiovascular events (CVE) and all-cause mortality (ACM) of CKD patients differs according to previous Type 2 Diabetes Mellitus (2TD) and/or Hypertension (HTN). Methods. We conducted a retrospective cohort study based on electronic health records of subjects aged 18–90 years old, with incident CKD between 1st January 2007 and 31st December 2017. The association between CKD groups according to previous T2D and/or HTN, and risk of ACM and CVE at follow-up were determined with Cox and Fine-Gray regressions, respectively. Results. 398,477 subjects were included. Median age was 74years, 55.2% were women. Individuals were distributed to HTN-CKD (51.9%), T2D-CKD (3.87%), HTN/T2D-CKD (31.4%) and unspecified-CKD (12.9%). In the multivariate analysis, with the T2D-CKD group as reference, the ACM Hazard Ratio (HR) was 0.645 (95%CI 0.624–0.667) in HTN-CKD, 0.704 (95%CI 0.682–0.728) in HTN/T2D-CKD and 0.875 (95%CI 0.844–0.908) in Unspecified-CKD group. The respective sub distribution HRs for CVE were 1.006 (CI95% 0.946–1.069), 1.238 (CI95% 1.164–1.316) and 0.722 (CI95% 0.665–0.785). Conclusion. In individuals with CKD, the risk of ACM and CVE differed according to previous HTN or/and T2D. These characteristics can help identifying individuals at higher risk of adverse outcomes, and improving the management of CKD patients in primary care.

scholarly journals Effect of Arteriovenous Fistula Creation on Systolic and Diastolic Blood Pressure in Patients With Pre-dialysis Advanced Chronic Kidney Disease

2019 ◽  
Vol 32 (9) ◽  
pp. 858-867 ◽  
Author(s):  
Roy O Mathew ◽  
Jerome Fleg ◽  
Janani Rangaswami ◽  
Bo Cai ◽  
Arif Asif ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Arteriovenous Fistula ◽  
Resistant Hypertension ◽  
Repeated Measures ◽  
Treatment Resistant ◽  
Advanced Chronic Kidney Disease ◽  
Stage Renal Disease ◽  
End Stage

AbstractBACKGROUNDCentral arteriovenous fistula (cAVF) has been investigated as a therapeutic measure for treatment-resistant hypertension in patients without advanced chronic kidney disease (CKD). There is considerable experience with the use of AVF for hemodialysis in patients with end-stage renal disease (ESRD). However, there is sparse data on the blood pressure (BP) effects of an AVF among patients with ESRD. We hypothesized that AVF creation would significantly reduce BP compared with patients who did not have an AVF among patients with ESRD before starting hemodialysis.METHODSBPs were compared during the 12 months before hemodialysis initiation in 399 patients with an AVF or AV graft created and 4,696 patients without either.RESULTSAfter propensity score matching 1:2 ratio (AVF to no AVF), repeated measures analysis of variance revealed significant reductions of –1.7 mm Hg systolic and –3.9 mm Hg diastolic BP 12 months in patients after AVF creation; P = 0.025 and P &lt; 0.001, respectively, compared with those with no AVF.CONCLUSIONSThese findings suggest that AVF creation results in modest BP reduction in patients with pre-dialysis ESRD who require AVF for eventual hemodialysis therapy. Preferential diastolic BP reduction suggests that greater work is needed to characterize the ideal patient subset in which to use cAVF for treatment-resistant hypertension in those without advanced CKD.

scholarly journals Blood Pressure Components and End-stage Renal Disease in Persons With Chronic Kidney Disease

2012 ◽  
Vol 172 (1) ◽  
pp. 41 ◽  
Author(s):  
Carmen A. Peralta ◽  
Keith C. Norris ◽  
Suying Li ◽  
Tara I. Chang ◽  
Manjula K. Tamura ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Stage Renal Disease ◽  
End Stage

scholarly journals Hypertension approach in patients with chronic kidney disease

Medic ro ◽  
2018 ◽  
Vol 125 (5) (1) ◽  
pp. 40-45
Author(s):  
Mihaela Daniela Baltă
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Ace Inhibitors ◽  
Cardiovascular Events ◽  
Pressure Control ◽  
Channel Blockers ◽  
Major Cardiovascular Events ◽  
Disease Rates ◽  
Risk Of Progression

Most patients with chronic kidney disease (CKD) have hypertension, and CKD is characterized by high and very high cardiovascular disease rates. Hypertension is an important cardiovascular risk factor, and its treatment prevents major cardiovascular events and lowers mortality of all causes and especially cardiovascular mortality. Therefore antihypertensive therapy is part of the management of chronic kidney disease. Effective blood pressure control decreases not only the risk of fatal and non-fatal cardiovascular events, but also reduces the rate of progression of renal impairment. Target bloodline values are not definitively established, but most guidelines recommend lowering systolic blood pressure to values below 140-130 mmHg, depending on the presence of proteinuria. Additional studies are needed to establish the blood pressure (BP) target, especially for patients with GFR below 45 ml/min./1.73 m2, where the benefits of too aggressive BP may be outweighed by the risk of progression to renal insufficiency. Most patients with chronic kidney disease require therapy with two or three therapeutic agents, the most commonly used drugs being ACE inhibitors/ARB (if there is intolerance to ACE inhibitors), calcium channel blockers and diuretics.

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