Evidence for reverse causality in the association between blood pressure and cardiovascular risk in patients with chronic kidney disease
Among those with moderate-to-advanced chronic kidney disease, the relationship between blood pressure and cardiovascular disease appears ‘U’-shaped, but is loglinear in apparently healthy adults. The Study of Heart and Renal Protection randomized 9270 patients with chronic kidney disease to simvasta...
| Autores principales: | , , , , , , , , , , , , , , |
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| Formato: | Journal article |
| Publicado: |
American Heart Association
2016
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| _version_ | 1826295145737224192 |
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| author | Herrington, W Staplin, N Judge, P Mafham, M Emberson, J Haynes, R Wheeler, D Walker, R Tomson, C Agodoa, L Wiecek, A Lewington, S Reith, C Landray, M Baigent, C |
| author_facet | Herrington, W Staplin, N Judge, P Mafham, M Emberson, J Haynes, R Wheeler, D Walker, R Tomson, C Agodoa, L Wiecek, A Lewington, S Reith, C Landray, M Baigent, C |
| author_sort | Herrington, W |
| collection | OXFORD |
| description | Among those with moderate-to-advanced chronic kidney disease, the relationship between blood pressure and cardiovascular disease appears ‘U’-shaped, but is loglinear in apparently healthy adults. The Study of Heart and Renal Protection randomized 9270 patients with chronic kidney disease to simvastatin/ezetimbe versus matching placebo, and measured blood pressure at each follow-up visit. Cox regression was used to assess the association between blood pressure and risk of cardiovascular disease among:(i) those with a self-reported history of cardiovascular disease; and (ii) those with no such history and, based on plasma troponin-I concentration, a low probability of subclinical cardiac disease. 8666 participants had a valid baseline blood pressure and troponin-I measurement and 2188 had at least one cardiovascular event during follow-up. After adjustment for relevant confounders, the association between systolic blood pressure and cardiovascular events was ‘U’-shaped, but among participants without evidence of prior cardiovascular disease, there was a positive loglinear association throughout the range of values studied. Among those with the lowest probability of subclinical cardiac disease, each 10mmHg higher systolic blood pressure corresponded to a 27% increased risk of cardiovascular disease (hazard ratio 1.27, 95% confidence interval 1.11-1.44). In contrast, the relationship between diastolic blood pressure and cardiovascular risk remained ‘U’-shaped irrespective of cardiovascular disease history or risk of subclinical disease. In conclusion, the lack of a clear association between systolic blood pressure and cardiovascular risk in this population appears attributable to confounding, suggesting that more intensive systolic blood pressure reduction may be beneficial in such patients. |
| first_indexed | 2024-03-07T03:56:33Z |
| format | Journal article |
| id | oxford-uuid:c30fd5d3-73e4-4cda-b437-88ce1b03cd9a |
| institution | University of Oxford |
| last_indexed | 2024-03-07T03:56:33Z |
| publishDate | 2016 |
| publisher | American Heart Association |
| record_format | dspace |
| spelling | oxford-uuid:c30fd5d3-73e4-4cda-b437-88ce1b03cd9a2022-03-27T06:13:46ZEvidence for reverse causality in the association between blood pressure and cardiovascular risk in patients with chronic kidney diseaseJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:c30fd5d3-73e4-4cda-b437-88ce1b03cd9aSymplectic Elements at OxfordAmerican Heart Association2016Herrington, WStaplin, NJudge, PMafham, MEmberson, JHaynes, RWheeler, DWalker, RTomson, CAgodoa, LWiecek, ALewington, SReith, CLandray, MBaigent, CAmong those with moderate-to-advanced chronic kidney disease, the relationship between blood pressure and cardiovascular disease appears ‘U’-shaped, but is loglinear in apparently healthy adults. The Study of Heart and Renal Protection randomized 9270 patients with chronic kidney disease to simvastatin/ezetimbe versus matching placebo, and measured blood pressure at each follow-up visit. Cox regression was used to assess the association between blood pressure and risk of cardiovascular disease among:(i) those with a self-reported history of cardiovascular disease; and (ii) those with no such history and, based on plasma troponin-I concentration, a low probability of subclinical cardiac disease. 8666 participants had a valid baseline blood pressure and troponin-I measurement and 2188 had at least one cardiovascular event during follow-up. After adjustment for relevant confounders, the association between systolic blood pressure and cardiovascular events was ‘U’-shaped, but among participants without evidence of prior cardiovascular disease, there was a positive loglinear association throughout the range of values studied. Among those with the lowest probability of subclinical cardiac disease, each 10mmHg higher systolic blood pressure corresponded to a 27% increased risk of cardiovascular disease (hazard ratio 1.27, 95% confidence interval 1.11-1.44). In contrast, the relationship between diastolic blood pressure and cardiovascular risk remained ‘U’-shaped irrespective of cardiovascular disease history or risk of subclinical disease. In conclusion, the lack of a clear association between systolic blood pressure and cardiovascular risk in this population appears attributable to confounding, suggesting that more intensive systolic blood pressure reduction may be beneficial in such patients. |
| spellingShingle | Herrington, W Staplin, N Judge, P Mafham, M Emberson, J Haynes, R Wheeler, D Walker, R Tomson, C Agodoa, L Wiecek, A Lewington, S Reith, C Landray, M Baigent, C Evidence for reverse causality in the association between blood pressure and cardiovascular risk in patients with chronic kidney disease |
| title | Evidence for reverse causality in the association between blood pressure and cardiovascular risk in patients with chronic kidney disease |
| title_full | Evidence for reverse causality in the association between blood pressure and cardiovascular risk in patients with chronic kidney disease |
| title_fullStr | Evidence for reverse causality in the association between blood pressure and cardiovascular risk in patients with chronic kidney disease |
| title_full_unstemmed | Evidence for reverse causality in the association between blood pressure and cardiovascular risk in patients with chronic kidney disease |
| title_short | Evidence for reverse causality in the association between blood pressure and cardiovascular risk in patients with chronic kidney disease |
| title_sort | evidence for reverse causality in the association between blood pressure and cardiovascular risk in patients with chronic kidney disease |
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