Blood Pressure Control in Young Adults with CKD

In middle-aged or older adults with chronic kidney disease (CKD), blood pressure control is a modifiable intervention for cardiovascular events and progression of CKD. However, according to Alexander J. Kula, MD, and colleagues, there are limited data available on the association between blood pressure and outcomes in young adults with CKD.

The researchers conducted an observational study among 317 young adults 21 to 40 years of age with mild-to-moderate CKD who were enrolled in the CRIC (Chronic Renal Insufficiency Cohort) study. Results were reported in the Journal of the American Society of Nephrology [2021;32(5):1200-1209].

Exposures included baseline systolic blood pressure evaluated continuously (per 10 mm Hg increase) and in categories (<120, 120-129, and ≥130 mm Hg). Primary outcomes of interest were cardiovascular events (heart failure, myocardial infarction, stroke, or all-cause death), and progression of CKD (defined as 50% decline in estimated glomerular filtration rate or end-stage kidney disease). Associations between baseline systolic blood pressure and cardiovascular events and CKD progression were examined using Cox proportional hazard models.

Of the 317 study participants, 52 had a cardiovascular event and 161 had CKD progression during median follow-up times of 11.3 years and 4.1 years, respectively. In the subgroup with baseline systolic blood pressure ≥130 mm Hg, 3% per year developed heart failure, 20% per year had progression of CKD, and 2% per year died.

In fully adjusted models, there were significant associations between baseline systolic blood pressure ≥130 mm Hg (versus systolic blood pressure <120 mm Hg) and cardiovascular events or death (hazard ratio [HR], 2.13; 95% confidence interval [CI], 1.05-4.32) and progression of CKD (HR, 1.68; 95% CI, 1.10-2.58).

In conclusion, the researchers said, “Among young adults with CKD, higher systolic blood pressure is significantly associated with a greater risk of cardiovascular events and CKD progression. Trials of blood pressure management are needed to test targets and treatment strategies, specifically in young adults with CKD.”