The association of blood pressure with mortality in chronic kidney disease seems to follow a J-shaped curve, especially with regard to diastolic pressure, according to an Annals of Internal Medicine study.
Researchers followed some 650,000 U.S. veterans with non-dialysis–dependent disease over a median of 6 years. After adjustment for such factors as age, diabetes, and cardiovascular disease, patients with blood pressure in the range of 130 to 159 mm Hg systolic and 70 to 89 diastolic had the lowest mortality risk. Even patients with “ideal” systolic blood pressure of less than 130 had increased mortality rates if their diastolic levels were under 70.
The association could be caused, the authors speculate, by lower coronary perfusion with decreased diastolic pressure. Editorialists (and the authors) emphasize the observational nature of the data, with the “attendant limitations,” and note the preponderance of male patients. “Translating these findings into practice is challenging,” they conclude.
Source: Annals of Internal Medicine article