Blood Pressure Components and End-Stage Renal Disease in Persons with Chronic Kidney Disease

The Kidney Early Evaluation Program (KEEP)

People with chronic kidney disease who have high blood pressure are at risk of progressing to end-stage renal disease. Meeting blood pressure goals, however, is challenging.

These researchers sought to determine the independent association between systolic and diastolic blood pressure (BP) and the risk of end-stage renal disease (ESRD). The participants were part of the Kidney Early Evaluation Program, a health screening program for people with kidney disease, a history of diabetes or hypertension, or a family history of kidney disease.

Compared to people with a systolic BP under 130 mm Hg, those with a systolic BP of 140 to 149 mm Hg had higher rates of ESRD; those with systolic BP 150 mm Hg had double rates of ESRD. Only persons with a diastolic BP of 90 mm Hg or higher remained at a significantly higher risk of ESRD compared with those with a diastolic BP of 60 to 74 mm Hg. Race, diabetes and severity of chronic kidney disease did not significantly modify these results.

These findings from a large, community-based study suggest that a blood pressure goal of 140/90, rather than the more aggressive and difficult-to-attain 130/80, may be sufficient for people with chronic kidney disease.