Association of blood pressure with cardiovascular outcome and mortality: results from the KNOW-CKD study

Jee Young Lee, Jung Tak Park, Young Su Joo, Changhyun Lee, Hae Ryong Yun, Tae Ik Chang, Yeong Hoon Kim, Woo Kyung Chung, Tae Hyun Yoo, Shin Wook Kang, Sue K. Park, Dong Wan Chae, Kook Hwan Oh, Seung Hyeok Han

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3 Citations (Scopus)


Background. Optimal blood pressure (BP) control is a major therapeutic strategy to reduce adverse cardiovascular events (CVEs) and mortality in patients with chronic kidney disease (CKD). We studied the association of BP with adverse cardiovascular outcome and all-cause death in patients with CKD. Methods. Among 2238 participants from the KoreaN cohort study for Outcome in patients With CKD (KNOW-CKD), 2226 patients with baseline BP measurements were enrolled. The main predictor was systolic BP (SBP) categorized by five levels: <110, 110–119, 120–129, 130–139 and ≥140 mmHg. The primary endpoint was a composite outcome of all-cause death or incident CVEs. We primarily used marginal structural models (MSMs) using averaged and the most recent time-updated SBPs. Results. During the follow-up of 10 233.79 person-years (median 4.60 years), the primary composite outcome occurred in 240 (10.8%) participants, with a corresponding incidence rate of 23.5 [95% confidence interval (CI) 20.7–26.6]/1000 patient-years. MSMs with averaged SBP showed a U-shaped relationship with the primary outcome. Compared with time-updated SBP of 110–119 mmHg, hazard ratios (95% CI) for <110, 120–129, 130–139 and ≥140 mmHg were 2.47 (1.48–4.11), 1.29 (0.80–2.08), 2.15 (1.26–3.69) and 2.19 (1.19–4.01), respectively. MSMs with the most recent SBP also showed similar findings. Conclusions. In Korean patients with CKD, there was a U-shaped association of SBP with the risk of adverse clinical outcomes. Our findings highlight the importance of BP control and suggest a potential hazard of SBP <110 mmHg.

Original languageEnglish
Pages (from-to)1722-1730
Number of pages9
JournalNephrology Dialysis Transplantation
Issue number9
Publication statusPublished - 2022 Sept 1

Bibliographical note

Funding Information:
This work was supported by the Research Program funded by the Korea Centers for Disease Control and Prevention (2011E3300300, 2012E3301100, 2013E3301600, 2013E3301601, 2013E3301602, 2016E3300200 and 2016E3300201).

Publisher Copyright:
© The Author(s) 2021.

All Science Journal Classification (ASJC) codes

  • Nephrology
  • Transplantation


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