Pilot Project Abstract - Weinstein, Jessica, MD

Weinstein, Jessica, MD, Postdoctoral Fellow, Dept. of Nephrology and Hypertension, OHSU

“A Retrospective Analysis of Hypertension Management in the Patients over age 75 with Chronic Kidney Disease: Is Systolic Blood Pressure of Less than 130 Associated with Benefit or Risk?”

We will conduct a retrospective cohort analysis of patients over age 75 with chronic kidney disease to evaluate rates of mortality, renal replacement therapy (RRT), and hospitalization in patients with a systolic blood pressure of greater than 160 mmHg, 130-160 mmHg, and less than 130 mmHg.

Chronic kidney disease (CKD) is a significant medical problem affecting 8% of the US population, leading to higher rates of mortality, cardiovascular disease, and healthcare expenditures. Hypertension management is of great importance in slowing the progression of CKD, but little is known about appropriate blood pressure goals in very aged CKD patients. National Kidney Foundation guidelines recommend blood pressure less than 130/80 mmHg for CKD patients; these guidelines are age neutral. In the past, very low blood pressure in elderly patients has been a marker for increased mortality. More recent data suggests that systolic blood pressure control of 140 to 150 mmHg in elderly patients without CKD results in decreased cardiovascular disease, stroke, and death. It is unknown if very elderly CKD patients would achieve additional benefit from blood pressure lowering to current CKD guidelines of <130/80 mmHg. We will identify outpatients age 75 or older with stage 3, 4, or 5 CKD (an estimated glomerular filtration rate (eGFR) of less than 60 ml/min/1.73 m2) for a retrospective cohort analysis. We hypothesize that CKD patients of advanced age (age greater than 75) will confer the same benefit of having a systolic blood pressure of less than 160 mmHg, but no benefit to having a systolic blood pressure of less than 130 mmHg. We will compare the rates of mortality, RRT, and hospitalizations in very aged patients with CKD who have an average systolic blood pressure of greater than 160 mmHg, 130 mmHg to 160 mmHg and less than 130 mmHg.