Elderly CKD Patients Need More Cautious Blood Pressure Management Strategies

MedicalResearch.com Interview with:

Csaba P Kovesdy MD Fred Hatch Professor of Medicine Director, Clinical Outcomes and Clinical Trials Program Division of Nephrology, University of Tennessee Health Science Center Nephrology Section Chief, Memphis VA Medical Center Memphis TN, 38163

Dr. Csaba P. Kovesdy

Csaba P Kovesdy MD
Fred Hatch Professor of Medicine
Director, Clinical Outcomes and Clinical Trials Program
Division of Nephrology, University of Tennessee Health Science Center
Nephrology Section Chief, Memphis VA Medical Center
Memphis TN, 38163

MedicalResearch.com: What is the background for this study?

Dr. Kovesdy: Older patients experience several physiologic changes which could modify their response to blood-pressure lowering. In fact, hypertension treatment guidelines such as JNC8 recommend slightly higher blood pressure targets when treating elderly patients. Patients with chronic kidney disease (CKD) have been excluded from most hypertension treatment trials, hence the blood pressure treatment goals in this group are mainly derived based on extrapolations. Even less is known about the effects of age on the association of blood pressure with mortality and various other clinical outcomes in patients with CKD.

MedicalResearch.com: What are the main findings?

Dr. Kovesdy: We examined the association between systolic blood pressure and mortality, incidence coronary heart disease (CHD), ischemic stroke and ESRD, and the effect of age on these associations in a cohort of 339,887 patients with incident chronic kidney disease. We found that systolic blood pressure above 130-139 mmHg was associated with higher risk of all outcomes, but the strength of the association was substantially weaker in older patients, especially those >80 years old.

MedicalResearch.com: What should clinicians and patients take away from your report?

Response: Our results reinforce that treatment of hypertension in younger patients with CKD towards targets recommended by current clinical guidelines is paramount in order to improve outcomes in these patients. In very elderly patients with chronic kidney disease a more cautious blood pressure lowering strategy may be reasonable.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Kovesdy: More clinical trials are needed to examine the effects of blood pressure lowering among the oldest patients with CKD.

Citation:

Csaba P. Kovesdy, Ahmed Alrifai, Elvira O. Gosmanova, Jun Ling Lu, Robert B. Canada, Barry M. Wall, Adriana M. Hung, Miklos Z. Molnar, and Kamyar Kalantar-Zadeh

Age and Outcomes Associated with BP in Patients with Incident CKD CJASN CJN.08660815; published ahead of print April 21, 2016, doi:10.2215/CJN.08660815

 

 

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