Blood pressure control may lower the risk of heart failure in patients with CKD
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Data presented at virtual 2021 ASN Kidney Week suggests “intensive blood pressure control” may reduce the risk of heart failure in patients with chronic kidney disease.
Previous studies have established that CKD is a risk factor for heart failure, but whether or not hypertension significantly affects the development of heart failure in CKD is unknown.
Sydney E. Hartsell, MD, MPH, from University of Utah School of Medicine, and colleagues evaluated data from 915,038 veterans with stage 3 CKD or greater and related their CKD stages at baseline with the time to HF hospitalizations and incident HF. Participants with baseline HF were excluded.
Researchers adjusted for demographics and baseline comorbidity in a multivariable Cox regression, then adjusted for baseline blood pressure and BP-lowering medications before conducting a time-varying Cox regression model with 3-month averages of BP values and BP-lowering medications.
“Every three months we averaged BP systolic and diastolic to create time-varying BP variables, and through August 2018 we collected our primary outcomes,” Hartsell said. “Those were incident heart failure, defined clinically by ICD codes and heart failure admissions, also defined by ICD codes.”
Among the patients with CKD, 111,549 (18%) developed heart failure and 29,597 (5%) were hospitalized for heart failure. Those with CKD stages higher than 3 were “significantly associated” with heart failure. Hartsell said that over the course of 8 years, 30% of patients with stage 5 CKD developed heart failure compared with only 20% of those of stage 3 CKD.
“Heart failure was more common among people with more advanced CKD,” Hartsell said in the virtual presentation. “Heart failure and prevalence are substantial in CKD. Adjusting for BP both systolic and diastolic and BP modulating medications attenuates the association of CKD stages with HF. Thus, intensive BP control may lower the risk of heart failure in patients with CKD.”
Hartsell added: “I was surprised that the baseline prevalence among veterans with CKD was 30%, far above the typical prevalence of heart failure in CKD according to Kidney Disease Improving Global Outcomes data (17-21%) — generating even more questions for another day.”
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Hartsell SE, et al. Poster TH-OR41 — 2021. Presented at: ASN Kidney Week. Nov. 4-7, 2021 (virtual meeting).
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