Disclosures: The authors report no relevant financial disclosures.
January 20, 2021
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Increases in blood pressure over time may better predict CKD progression

Disclosures: The authors report no relevant financial disclosures.
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Although higher systolic blood pressure at baseline was associated with eGFR decline in patients with chronic kidney disease, disease progression may be more accurately predicted when blood pressure is measured over time.

Jee Young Lee, MD, of the Institute of Kidney Disease Research at Yonsei University in Seoul, South Korea, and colleagues contended that most clinical trials examining blood pressure control have placed cardiovascular outcomes and mortality at the forefront, studying adverse kidney events as secondary outcomes.

Blood pressure cuff
Source: Adobe Stock

Therefore, they wrote, “optimal BP control for preventing kidney disease progression in patients with CKD remains debated.”

To investigate, they included 2,044 with CKD, considering a composite outcome of a 50% or greater decline in eGFR from baseline or the onset of ESKD. The main predictors for disease progression were baseline and time-updated systolic and diastolic blood pressure (median number of measurements per patient was four).

The researchers found patients with baseline systolic blood pressure (SBP) of 120 mm Hg or greater were more likely to experience CKD progression, with the association being more pronounced in the time-updated models. In addition, patients with SBP 120 mm Hg or greater had steeper slopes of eGFR decline.

Regarding diastolic blood pressure (DBP), only the time-updated measure was significantly associated with CKD progression.

“These findings suggest that time-updated BP is a better predictor of kidney function decline than a single measured baseline BP, and SBP may affect kidney outcomes more than DBP,” Lee and colleagues concluded.