Pulse Pressure and Cardiovascular and Kidney Outcomes by Age in the Chronic Renal Insufficiency Cohort (CRIC)

Clara J Fischman; Raymond R Townsend; Debbie L Cohen; Mahboob Rahman; Matthew R Weir; Stephen P Juraschek; Andrew M South; Lawrence J Appel; Paul Drawz; Jordana B Cohen; CRIC Study Investigators

doi:10.1093/ajh/hpae136

Pulse Pressure and Cardiovascular and Kidney Outcomes by Age in the Chronic Renal Insufficiency Cohort (CRIC)

Am J Hypertens. 2024 Oct 22:hpae136. doi: 10.1093/ajh/hpae136. Online ahead of print.

Authors

Clara J Fischman¹, Raymond R Townsend², Debbie L Cohen², Mahboob Rahman³, Matthew R Weir⁴, Stephen P Juraschek⁵, Andrew M South^{6

7

8

9}, Lawrence J Appel^{10

11

12}, Paul Drawz¹³, Jordana B Cohen^{2

14}; CRIC Study Investigators

Collaborators

CRIC Study Investigators:
Amanda H Anderson, Jing Chen, Laura M Dember, Alan S Go, James P Lash, Panduranga S Rao, Vallabh O Shah, Mark L Unruh

Affiliations

¹ Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
² Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
³ Department of Medicine, Case Western Reserve University, Cleveland, OH, USA.
⁴ Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
⁵ Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
⁶ Section of Nephrology, Department of Pediatrics, Brenner Children's, Wake Forest University School of Medicine, Winston Salem, NC, USA.
⁷ Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston Salem, NC, USA.
⁸ Department of Surgery-Hypertension and Vascular Research, Wake Forest University School of Medicine, Winston Salem, NC, USA.
⁹ Cardiovascular Sciences Center, Wake Forest University School of Medicine, Winston Salem, NC, USA.
¹⁰ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
¹¹ Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University and Medical Institutions, Baltimore, MD, USA.
¹² Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
¹³ Division of Nephrology and Hypertension, University of Minnesota Medical School, Minneapolis, MN, USA.
¹⁴ Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.

PMID: 39437324
DOI: 10.1093/ajh/hpae136

Abstract

Background: Wide pulse pressure (PP) is associated with cardiovascular events and the progression of chronic kidney disease (CKD) to kidney failure. PP naturally widens with age, but it is unclear whether the risks associated with greater PP are the same across all ages.

Methods: We used Cox proportional hazards models to investigate the association of PP with (i) atherosclerotic cardiovascular disease (ASCVD) events or death and (ii) a 50% reduction in estimated glomerular filtration rate or kidney failure in the chronic renal insufficiency cohort (CRIC). We evaluated the association of time-updated PP with these outcomes, accounting for time-updated confounders using inverse probability weighting.

Results: Among 5,621 participants with CKD, every 10-mmHg greater PP was associated with a 6% higher risk of an ASCVD event or death (hazard ratio [HR] = 1.06, 95% CI 1.04, 1.08) and 17% higher risk of the composite kidney outcome (HR = 1.17, 95% CI 1.16, 1.18). Greater PP was associated with a higher risk of ASCVD events or death among participants in the lowest age tertile (21-61 years), but a higher risk of the composite kidney outcome in the oldest age tertile (71-79 years). While wide PP in participants that experienced the primary outcomes was predominantly driven by elevated SBP, PP remained significantly associated with the composite kidney outcome across all ages and with ASCVD events or death in the first age tertile when SBP was added to the Cox regression model.

Conclusions: Our findings suggest that the mechanism by which PP is associated with adverse outcomes may differ by age.

Keywords: atherosclerotic cardiovascular disease; blood pressure; chronic kidney disease; kidney failure; large artery stiffness; pulse pressure.

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Abstract

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