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논문분류	춘계학술대회 초록집
제목	Blood Pressure and Cardiovascular Events in Advanced Chronic Kidney Disease: Findings from the Chronic Renal Insufficiency Cohort and KoreaN Cohort Study for Outcome in Patients with Chronic Kidney Disease Studies
저자	Cheol Ho Park
출판정보	2026; 2026(1):
키워드	blood pressure, cardiovascular event, chronic kidney disease
초록	Objectives: Patients with advanced chronic kidney disease (CKD) face a high burden of cardiovascular events, but evidence on the optimal blood pressure (BP) targets to prevent these outcomes is scarce in this population. Methods: We analyzed 2,922 participants with CKD G3b–G5 without kidney replacement therapy from two large prospective CKD cohorts in the United States and Korea. The main exposure was baseline and time-updated systolic BP (SBP). The primary outcome was a composite outcome of myocardial infarction, stroke, hospitalization for heart failure, or cardiovascular-related death. We used cause-specific hazards models and marginal structural models for baseline and time-updated SBP, respectively. Results: During 17,114 person-years of follow-up (median, 4.6 years), 603 (20.6%) participants experienced the primary outcome. Compared with baseline SBP ≥140 mmHg, the hazard ratios (HRs) (95% confidence intervals [CIs]) for <110, 110–119, 120–129, and 130–139 mmHg were 0.58 (0.44–0.76), 0.68 (0.53–0.89), 0.77 (0.61–0.97), and 0.80 (0.63–1.02), respectively, indicating a graded association between SBP and cardiovascular events , with reduced risk of primary outcome in patients with a lower SBP. Time-updated analysis showed consistent associations. The corresponding HRs (95% CIs) were 0.65 (0.47–0.91), 0.72 (0.53–0.98), 0.90 (0.68–1.20), and 0.93 (0.65–1.31). Additionally, a 10-mmHg decrease in baseline and time-updated SBP was associated with an 8% (HR, 0.92;95% CI, 0.89–0.96) and 7% (HR, 0.93;95% CI, 0.88–0.99) lower risk of the composite cardiovascular outcome, respectively. Conclusion: In patients with CKD G3b–G5, a lower SBP was associated with a decreased risk of adverse cardiovascular events. These findings cautiously support the potential benefit of targeting SBP below conventional high ranges in advanced CKD, while underscoring the need for randomized trials to define optimal BP targets.
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