A recent study published in the Kidney Medicine provided crucial insights into the management of blood pressure in patients with chronic kidney disease (CKD). The study, conducted within the Chronic Renal Insufficiency Cohort (CRIC) study, focused on isolated diastolic hypertension and its potential impact on kidney and cardiovascular outcomes.
Isolated diastolic hypertension occurs when systolic blood pressure (SBP) is controlled but diastolic blood pressure (DBP) remains high. In this study, 6.2% of the 5,621 participants exhibited isolated diastolic hypertension, defined as SBP ≤ 130 mm Hg and DBP >80 mm Hg. The reference group had normal blood pressure, defined as SBP ≤ 130 mm Hg and DBP ≤ 80 mm Hg.

The research aimed to determine whether isolated diastolic hypertension was associated with adverse kidney and cardiovascular outcomes. The findings were clear: there was no significant association between isolated diastolic hypertension and the risk of adverse kidney outcomes (such as a 50% decline in estimated glomerular filtration rate or kidney failure), composite cardiovascular events (including myocardial infarction, heart failure, stroke, or peripheral arterial disease), or all-cause mortality.
The study's analytical approach involved Cox proportional hazards models adjusted for demographic, health behavior, and clinical covariates. Despite the limitations of the study, including the relatively small sample size and the older age of the cohort, these findings provide valuable insights for clinicians and patients dealing with CKD.
This study helps address a common dilemma for healthcare professionals managing patients with kidney disease who have controlled systolic blood pressure but elevated diastolic blood pressure. In such cases, it was often uncertain whether intensifying blood pressure treatment to control diastolic blood pressure was necessary. However, based on the study's results, it suggests that, in patients with chronic kidney disease, there may not be a need to increase blood pressure medications solely to improve diastolic blood pressure control if systolic blood pressure is already well controlled.
Reference:
Al Saleh, S., Dobre, M., DeLozier, S., Perez, J., Patil, N., Rahman, M., & Pradhan, N. (2023). Isolated Diastolic Hypertension and Kidney and Cardiovascular Outcomes in CKD: The Chronic Renal Insufficiency Cohort (CRIC) Study. In Kidney Medicine (p. 100728). Elsevier BV. https://doi.org/10.1016/j.xkme.2023.100728