Diastolic BP treatment may not be needed in patients with CKD if systolic BP is controlled
Click Here to Manage Email Alerts
Key takeaway:
- In patients with CKD, isolated diastolic hypertension did not increase risk of adverse cardiovascular and kidney outcomes.
- Intensification of anti-hypertensive therapy may not be necessary in these patients.
In patients with chronic kidney disease, high diastolic blood pressure did not increase risk for adverse kidney or cardiovascular events if systolic BP is under control, according to a study published in Kidney Medicine.
“We frequently encounter patients who have controlled systolic BP and uncontrolled diastolic BP in the setting of chronic kidney disease and are faced with the dilemma of whether to intensify anti-hypertensive therapy or not,” Nishigandha Pradhan, MD, nephrologist at University Hospitals and assistant professor in the division of nephrology and hypertension at Case Western Reserve University, told Healio. “Our findings provide reassurance that it is not harmful to not intensify anti-hypertensive therapy for the sole purpose of better controlling diastolic BP as long as systolic BP is at goal.”
In the prospective cohort study, researchers tracked adverse kidney or cardiovascular events or death in 5,621 patients with CKD during a median follow-up of 16.9 years.
At baseline, 2,919 patients were categorized as normotensive and served as the reference group. A total of 1,447 patients had isolated systolic hypertension, 908 had systolic diastolic hypertension and 347, or 6.2% of the overall cohort, had isolated diastolic hypertension. Compared with the normotensive group, there was no statistically significant difference in the risk of developing composite kidney outcome (HR = 1.17; 95% CI, 0.93-1.47), composite cardiovascular outcome (HR = 0.91; 95% CI, 0.65-1.27) or all-cause mortality (HR = 0.82; 95% CI, 0.57-1.19), according to the study results.
In comparison, isolated systolic hypertension increased the risk for composite cardiovascular events (HR = 1.20; 95% CI, 1.03-1.39). Systolic diastolic hypertension increased the risk of composite cardiovascular outcomes (adjusted HR = 1.41; 95% CI, 1.17-1.71) and all-cause mortality (adjusted HR = 1.42; 95% CI, 1.16-1.74).
“We had expected to see worse outcomes in patients with uncontrolled diastolic hypertension, which was not seen in our study,” Pradhan said. “Randomized controlled trials with differentiated target diastolic BPs and their correlation with cardiovascular and kidney outcomes are required to confirm our observation and further guide BP treatment in these instances.”
Collapse
Click Here to Manage Email Alerts