Having too-low diastolic blood pressure (DBP) may be deadly for patients with chronic kidney disease (CKD). Blood pressure (BP) recommendations are stricter for patients with CKD than for the general population and focus on lowering actual BP (the measurement of both systolic BP [SBP] and DBP) without consideration for achieving a DBP that is too low.
Researchers reviewed health records for 651,749 U.S. veterans with CKD to assess the association between BP and death. Both actual BP and measurements of SBP and DBP considered separately were assessed.
The researchers found that having a systolic blood pressure of 130 to 159 mm Hg and diastolic blood pressure of 70 to 89 mm Hg was associated with the lowest risk for death. Patients with a DBP less than 70 mm Hg, regardless of their SBP, had higher mortality rates.
An accompanying editorial highlights some of the limitations of the study. Among them, the authors suggest that it may not be BP combination but instead the characteristics of the persons with that combination that lead to greater mortality risk.
Blood Pressure and Mortality in U.S. Veterans With Chronic Kidney Disease: A Cohort Study, Csaba P. Kovesdy, MD; Anthony J. Bleyer, MD; Miklos Z. Molnar, MD, PhD; Jennie Z. Ma, PhD; John J. Sim, MD; William C. Cushman, MD; L. Darryl Quarles, MD; and Kamyar Kalantar-Zadeh, MD, PhD, Ann Intern Med. 2013;159(4):233-242. doi:10.7326/0003-4819-159-4-201308200-00004