Skip to main content

Main menu

  • Home
  • Content
    • Published Ahead of Print
    • Current Issue
    • Podcasts
    • Subject Collections
    • Archives
    • Kidney Week Abstracts
    • Saved Searches
  • Authors
    • Submit a Manuscript
    • Author Resources
  • Trainees
    • Peer Review Program
    • Prize Competition
  • About CJASN
    • About CJASN
    • Editorial Team
    • CJASN Impact
    • CJASN Recognitions
  • More
    • Alerts
    • Advertising
    • Feedback
    • Reprint Information
    • Subscriptions
  • ASN Kidney News
  • Other
    • ASN Publications
    • JASN
    • Kidney360
    • Kidney News Online
    • American Society of Nephrology

User menu

  • Subscribe
  • My alerts
  • Log in
  • My Cart

Search

  • Advanced search
American Society of Nephrology
  • Other
    • ASN Publications
    • JASN
    • Kidney360
    • Kidney News Online
    • American Society of Nephrology
  • Subscribe
  • My alerts
  • Log in
  • My Cart
Advertisement
American Society of Nephrology

Advanced Search

  • Home
  • Content
    • Published Ahead of Print
    • Current Issue
    • Podcasts
    • Subject Collections
    • Archives
    • Kidney Week Abstracts
    • Saved Searches
  • Authors
    • Submit a Manuscript
    • Author Resources
  • Trainees
    • Peer Review Program
    • Prize Competition
  • About CJASN
    • About CJASN
    • Editorial Team
    • CJASN Impact
    • CJASN Recognitions
  • More
    • Alerts
    • Advertising
    • Feedback
    • Reprint Information
    • Subscriptions
  • ASN Kidney News
  • Visit ASN on Facebook
  • Follow CJASN on Twitter
  • CJASN RSS
  • Community Forum
Editorials
You have accessRestricted Access

The Continued Quest for Optimal BP Targets in Older Adults with Kidney Disease

Jessica W. Weiss
CJASN May 2016, 11 (5) 753-755; DOI: https://doi.org/10.2215/CJN.03100316
Jessica W. Weiss
Division of Nephrology and Hypertension, Department of Internal Medicine, Oregon Health and Science University, Portland, Oregon
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Info & Metrics
  • View PDF
Loading
  • chronic renal disease
  • blood pressure
  • elderly
  • Adult
  • Blood Pressure Determination
  • Humans
  • Kidney Diseases

Since the landmark Veteran’s Affairs Cooperative Trials of the late 1960s to 1970s, hypertension management has played a central role in efforts to decrease cardiovascular risk (1,2). Given the prevalence of isolated systolic hypertension in older adults, later studies in older populations focused on systolic BP (SBP) targets; trials of older adults (mean age >60 years old) who were treated to specific BP goals showed decreased cardiovascular risk when SBP was controlled to <150 mmHg compared with higher targets (3–6). The value of more intensive SBP control (to levels well below 150 mmHg) continues to be the source of significant debate. Two studies among older Japanese adults failed to find a reduction in a composite cardiovascular outcome with lower versus higher targets (SBP<140 versus <150 mmHg or <160 mmHg) (7,8). Also, the recent Action to Control Cardiovascular Risk in Diabetes Trial did not find any difference in a composite cardiovascular outcome with more (SBP<120 mmHg) versus less intensive (SBP<140 mmHg) control among adults with diabetes (mean age =62 years old) (9). Importantly, the majority of these trials incorporated creatinine ceilings in their entry criteria, which resulted in the exclusion of patients who had anything beyond moderate reductions in eGFR. The lack of evidence to support the benefits of aggressive BP lowering for older adults led the Eighth Joint National Committee to recommend more liberal BP targets for adults ages >60 years old (<150/90 mmHg) (10). Of note, CKD-specific guidance within this report continued to recommend a lower BP target (<140/90 mmHg) for patients with CKD of all ages largely on the basis of expert opinion. The more recent Systolic Blood Pressure Intervention Trial (SPRINT) intentionally included adults with CKD as well as older adults to help address knowledge gaps about intensive BP lowering in these populations, although those with more severe reductions of eGFR were still excluded (11). The SPRINT found a lower risk of cardiovascular events and mortality among adults treated to SBP targets of <120 versus <140 mmHg in the overall analysis and across all subgroup analyses, including the CKD population; the contrast between these and previous treat to target BP trial results calls into question the appropriateness of recent guideline recommendations.

In this issue of the Clinical Journal of the American Society of Nephrology, Kovesdy et al. (12) add to the collective understanding of the relationship between BP and a wide range of clinical outcomes in older adults with incident CKD. In a large retrospective cohort of United States veterans, Kovesdy et al. (12) identified a U-shaped relationship between SBP and examined outcomes (mortality, incident coronary heart disease, incident stroke, and ESRD). Kovesdy et al. (12) found that both SBP≥140 and <120 mmHg were associated with an increased risk of all examined outcomes compared with SBP=130–139 mmHg, but the magnitude of risk associated with a given level of BP was attenuated with advancing age. For example, when SBP was ≥170 mmHg, the hazard ratios for mortality were 2.01, 1.68, 1.39, and 1.30 for ages 50–59, 60–69, 70–79, and ≥80 years old, respectively. Of note, for incident coronary heart disease and incident stroke, the hazard ratios were slightly higher in those ages ≥80 years old compared with those ages 70–79 years old when SBP =140–149 (1.3 versus 1.08 for coronary heart disease, respectively, and 1.23 versus 1.1 for stroke, respectively). Among adults ages ≥80 years old, however, the relative risk of these two outcomes remained relatively stable across SBP groups >140 mmHg, whereas the risk increased linearly with increasing SBP in younger patients.

These results are consistent with an earlier study by Kovesdy et al. (13), which described a U-shaped relationship between BP and all-cause mortality (lowest risk of mortality seen in those with BP=130–159/70–89 mmHg) in a national cohort of veterans with CKD. In a previous study of older adults with CKD, we also described a U-shaped relationship between SBP and mortality (increased risk of mortality with SBP>140 and <130 mmHg compared with 130–139 mmHg) among adults ages 65–70 years old but found no increase in risk of death at higher levels of SBP for those ages ≥70 years old (14). In our previous analysis (14) and in this study (12), there was not a definitive increase in the relative risk of mortality for adults ages ≥80 years old when SBP was 140–149 or 150–159 mmHg (confidence intervals included unity). Kovesdy et al. (12) expanded on this, however, via a more finely stratified analysis of higher SBP levels, which found an increase in relative risk of death even among those ≥80 years old when SBP was >160 mmHg. This suggests that a U-shaped relationship between BP and mortality was present even among the oldest participants but that the threshold where risk of death increases relative to SBP varied with age.

This study (12) identified an increased risk of mortality with lower diastolic BP (DBP; DBP<60 mmHg) but no association between higher levels of DBP (>80 mmHg) and examined outcomes; this finding is consistent with previous work by Kovesdy et al. (13) and our group (14). The risk of isolated systolic hypertension increases as eGFR declines, and lower levels of DBP have been associated with increased risk of mortality and cardiovascular events (3,15–17). The comparative benefits of lowering SBP versus allowing DBP to stay >60 mmHg, particularly among patients with renal disease, remain unclear.

High–quality observational data, such as those presented here by Kovesdy et al. (12), play a pivotal role in deciphering the relationship between BP and important outcomes in a subset of patients, older adults with CKD, who are unlikely to be comprehensively evaluated in a clinical trial. Those patient characteristics that make decisions about BP targets most challenging in a real world clinic setting, including dementia, frailty, and poor functional status, are extremely common among older adults with CKD and portend a worse prognosis, including an increased risk of death (18–20); unfortunately, these characteristics often serve as indications to exclude these patients from trial populations. The majority of clinical trials of more versus less intensive BP control in older adults, including the SPRINT, excluded adults with a prior diagnosis of dementia and excluded on the basis of criteria likely related to poor functional status, such as inability to sit or stand, presence of medical management problems, or residence in a skilled nursing facility (4–6,9,11,21).

In addition, clinical trials frequently exclude or limit inclusion of patients who have comorbidities that can influence the outcome of interest. In trials of BP management, this has often resulted in trial populations with a lesser burden of those severe comorbidities that may limit life expectancy and otherwise complicate everyday decisions about BP management. In trials of hypertension management, preexisting heart failure (especially symptomatic disease or New York Heart Association class 3/4), cancer, and diseases likely to limit life expectancy have been excluded by most major trials, including the SPRINT (5,7–9,11,21–23). Although observational cohort analyses cannot establish causation, age- and comorbidity-specific evaluations in real world populations may provide a unique window into possible risks and benefits of hypertension management most pertinent to the older adult with complex comorbidity.

The observational nature of this study does impose some limitations, including the concern for residual confounding. In addition, although inclusion of frailty within this analysis would be ideal, use of a low body mass index/weight loss combined variable to identify frailty is complicated by the many clinical factors that can alter these characteristics—most notably, the use of diuretics for management of edema or heart failure. Furthermore, this variable alone is not an adequate surrogate for frailty, because even if truly representative of unintentional weight loss, weight loss alone speaks to only one factor in the most validated and accepted definition of frailty (24). Whereas frailty has been associated with an increased risk of mortality in previous studies, the presence of low body mass index/weight loss was not associated with increased risk of any examined outcome in this analysis (20). In addition, although the inclusion of the Charlson–Deyo comorbidity index in this analysis is commendable, because of its incorporation as a dichotomous variable this addition is unlikely to fully adjust or account for the role that comorbidity may play in the relationship between BP and examined outcomes (25,26). These results may also not be generalizable to women given that the cohort was comprised predominantly of men.

The results of this observational study provide novel insight into the complex relationships between BP and health outcomes and may be helpful in guiding the design of future trials to address the value of differing BP targets in older adults with CKD (12). These results may also add a note of caution to newfound enthusiasm for lower BP targets after the release of the SPRINT via the suggestion that harm may persist at upper and lower extremes of BP among populations more comorbid and complex than those evaluated in the setting of a clinical trial. Ideally, future studies may continue to expand our knowledge in this area with more detailed exploration of the potential modifying effect of comorbidity and frailty on the association between BP and outcomes in older adults. For now, a tailored application of available data to the constellation of comorbidities and health care priorities of a particular patient remains the best approach for individualized hypertension management among older adults with CKD.

Disclosures

None.

Footnotes

  • Published online ahead of print. Publication date available at www.cjasn.org.

  • See related article, “Age and Outcomes Associated with BP in Patients with Incident CKD” on pages 821–831.

  • Copyright © 2016 by the American Society of Nephrology

References

  1. ↵
    Anonymous: Effects of treatment on morbidity in hypertension. Results in patients with diastolic blood pressures averaging 115 through 129 mm Hg. JAMA 202: 1028–1034, 1967
    OpenUrlCrossRefPubMed
  2. ↵
    Anonymous: Effects of treatment on morbidity in hypertension. II. Results in patients with diastolic blood pressure averaging 90 through 114 mm Hg. JAMA 213: 1143–1152, 1970
    OpenUrlCrossRefPubMed
  3. ↵
    1. Franklin SS,
    2. Jacobs MJ,
    3. Wong ND,
    4. L’Italien GJ,
    5. Lapuerta P
    : Predominance of isolated systolic hypertension among middle-aged and elderly US hypertensives: Analysis based on National Health and Nutrition Examination Survey (NHANES) III. Hypertension 37: 869–874, 2001
    OpenUrlCrossRef
  4. ↵
    SHEP Cooperative Research Group: Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA 265: 3255–3264, 1991
    OpenUrlCrossRefPubMed
  5. ↵
    1. Staessen JA,
    2. Fagard R,
    3. Thijs L,
    4. Celis H,
    5. Arabidze GG,
    6. Birkenhäger WH,
    7. Bulpitt CJ,
    8. de Leeuw PW,
    9. Dollery CT,
    10. Fletcher AE,
    11. Forette F,
    12. Leonetti G,
    13. Nachev C,
    14. O’Brien ET,
    15. Rosenfeld J,
    16. Rodicio JL,
    17. Tuomilehto J,
    18. Zanchetti A
    ; The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators: Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. Lancet 350: 757–764, 1997
    OpenUrlCrossRefPubMed
  6. ↵
    1. Beckett NS,
    2. Peters R,
    3. Fletcher AE,
    4. Staessen JA,
    5. Liu L,
    6. Dumitrascu D,
    7. Stoyanovsky V,
    8. Antikainen RL,
    9. Nikitin Y,
    10. Anderson C,
    11. Belhani A,
    12. Forette F,
    13. Rajkumar C,
    14. Thijs L,
    15. Banya W,
    16. Bulpitt CJ
    ; HYVET Study Group: Treatment of hypertension in patients 80 years of age or older. N Engl J Med 358: 1887–1898, 2008
    OpenUrlCrossRefPubMed
  7. ↵
    JATOS Study Group: Principal results of the Japanese trial to assess optimal systolic blood pressure in elderly hypertensive patients (JATOS). Hypertens Res 31: 2115–2127, 2008
    OpenUrlCrossRefPubMed
  8. ↵
    1. Ogihara T,
    2. Saruta T,
    3. Rakugi H,
    4. Matsuoka H,
    5. Shimamoto K,
    6. Shimada K,
    7. Imai Y,
    8. Kikuchi K,
    9. Ito S,
    10. Eto T,
    11. Kimura G,
    12. Imaizumi T,
    13. Takishita S,
    14. Ueshima H
    ; Valsartan in Elderly Isolated Systolic Hypertension Study Group: Target blood pressure for treatment of isolated systolic hypertension in the elderly: Valsartan in elderly isolated systolic hypertension study. Hypertension 56: 196–202, 2010
    OpenUrlCrossRef
  9. ↵
    1. Cushman WC,
    2. Evans GW,
    3. Byington RP,
    4. Goff DC Jr..,
    5. Grimm RH Jr..,
    6. Cutler JA,
    7. Simons-Morton DG,
    8. Basile JN,
    9. Corson MA,
    10. Probstfield JL,
    11. Katz L,
    12. Peterson KA,
    13. Friedewald WT,
    14. Buse JB,
    15. Bigger JT,
    16. Gerstein HC,
    17. Ismail-Beigi F
    ; ACCORD Study Group: Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med 362: 1575–1585, 2010
    OpenUrlCrossRefPubMed
  10. ↵
    1. James PA,
    2. Oparil S,
    3. Carter BL,
    4. Cushman WC,
    5. Dennison-Himmelfarb C,
    6. Handler J,
    7. Lackland DT,
    8. LeFevre ML,
    9. MacKenzie TD,
    10. Ogedegbe O,
    11. Smith SC Jr..,
    12. Svetkey LP,
    13. Taler SJ,
    14. Townsend RR,
    15. Wright JT Jr..,
    16. Narva AS,
    17. Ortiz E
    : 2014 evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 311: 507–520, 2014
    OpenUrlCrossRefPubMed
  11. ↵
    1. Wright JT Jr..,
    2. Williamson JD,
    3. Whelton PK,
    4. Snyder JK,
    5. Sink KM,
    6. Rocco MV,
    7. Reboussin DM,
    8. Rahman M,
    9. Oparil S,
    10. Lewis CE,
    11. Kimmel PL,
    12. Johnson KC,
    13. Goff DC Jr..,
    14. Fine LJ,
    15. Cutler JA,
    16. Cushman WC,
    17. Cheung AK,
    18. Ambrosius WT
    ; SPRINT Research Group: A randomized trial of intensive versus standard blood-pressure control. N Engl J Med 373: 2103–2116, 2015
    OpenUrlCrossRefPubMed
  12. ↵
    1. Kovesdy CP,
    2. Alrifai A,
    3. Gosmanova EO,
    4. Lu JL,
    5. Canada RB,
    6. Wall BM,
    7. Hung AM,
    8. Molnar MZ,
    9. Kalantar-Zadeh K
    : Age and outcomes associated with BP in patients with incident CKD. Clin J Am Soc Nephrol 11: 821–831, 2016
    OpenUrlAbstract/FREE Full Text
  13. ↵
    1. Kovesdy CP,
    2. Bleyer AJ,
    3. Molnar MZ,
    4. Ma JZ,
    5. Sim JJ,
    6. Cushman WC,
    7. Quarles LD,
    8. Kalantar-Zadeh K
    : Blood pressure and mortality in U.S. veterans with chronic kidney disease: A cohort study. Ann Intern Med 159: 233–242, 2013
    OpenUrlCrossRefPubMed
  14. ↵
    1. Weiss JW,
    2. Peters D,
    3. Yang X,
    4. Petrik A,
    5. Smith DH,
    6. Johnson ES,
    7. Thorp ML,
    8. Morris C,
    9. O’Hare AM
    : Systolic BP and mortality in older adults with CKD. Clin J Am Soc Nephrol 10: 1553–1559, 2015
    OpenUrlAbstract/FREE Full Text
  15. ↵
    1. Ungar A,
    2. Pepe G,
    3. Lambertucci L,
    4. Fedeli A,
    5. Monami M,
    6. Mannucci E,
    7. Gabbani L,
    8. Masotti G,
    9. Marchionni N,
    10. Di Bari M
    : Low diastolic ambulatory blood pressure is associated with greater all-cause mortality in older patients with hypertension. J Am Geriatr Soc 57: 291–296, 2009
    OpenUrlCrossRefPubMed
    1. Somes GW,
    2. Pahor M,
    3. Shorr RI,
    4. Cushman WC,
    5. Applegate WB
    : The role of diastolic blood pressure when treating isolated systolic hypertension. Arch Intern Med 159: 2004–2009, 1999
    OpenUrlCrossRefPubMed
  16. ↵
    1. Cheng LT,
    2. Gao YL,
    3. Gu Y,
    4. Zhang L,
    5. Bi SH,
    6. Tang W,
    7. Wang T
    : Stepwise increase in the prevalence of isolated systolic hypertension with the stages of chronic kidney disease. Nephrol Dial Transplant 23: 3895–3900, 2008
    OpenUrlCrossRefPubMed
  17. ↵
    1. Roshanravan B,
    2. Khatri M,
    3. Robinson-Cohen C,
    4. Levin G,
    5. Patel KV,
    6. de Boer IH,
    7. Seliger S,
    8. Ruzinski J,
    9. Himmelfarb J,
    10. Kestenbaum B
    : A prospective study of frailty in nephrology-referred patients with CKD. Am J Kidney Dis 60: 912–921, 2012
    OpenUrlCrossRefPubMed
    1. Reese PP,
    2. Cappola AR,
    3. Shults J,
    4. Townsend RR,
    5. Gadegbeku CA,
    6. Anderson C,
    7. Baker JF,
    8. Carlow D,
    9. Sulik MJ,
    10. Lo JC,
    11. Go AS,
    12. Ky B,
    13. Mariani L,
    14. Feldman HI,
    15. Leonard MB
    ; CRIC Study Investigators: Physical performance and frailty in chronic kidney disease. Am J Nephrol 38: 307–315, 2013
    OpenUrlCrossRefPubMed
  18. ↵
    1. Wilhelm-Leen ER,
    2. Hall YNK,
    3. K Tamura M,
    4. Chertow GM
    : Frailty and chronic kidney disease: The third national health and nutrition evaluation survey. Am J Med 122: 664–671.e2, 2009
    OpenUrlCrossRefPubMed
  19. ↵
    1. Amery A,
    2. Birkenhäger W,
    3. Brixko P,
    4. Bulpitt C,
    5. Clement D,
    6. Deruyttere M,
    7. De Schaepdryver A,
    8. Dollery C,
    9. Fagard R,
    10. Forette F,
    11. Forte J,
    12. Hamdy R,
    13. Henry JF,
    14. Joosens JV,
    15. Leonetti G,
    16. Lund-Johansen P,
    17. O'Malley K,
    18. Petrie J,
    19. Strasser T,
    20. Tuomilehto J,
    21. Williams B
    : Mortality and morbidity results from the european working party on high blood pressure in the elderly trial. Lancet 1: 1349–1354, 1985
    OpenUrlPubMed
    1. Hansson L,
    2. Zanchetti A,
    3. Carruthers SG,
    4. Dahlöf B,
    5. Elmfeldt D,
    6. Julius S,
    7. Ménard J,
    8. Rahn KH,
    9. Wedel H,
    10. Westerling S
    ; HOT Study Group: Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: Principal results of the Hypertension Optimal Treatment (HOT) randomised trial. Lancet 351: 1755–1762, 1998
    OpenUrlCrossRefPubMed
  20. ↵
    1. Ogihara T,
    2. Saruta T,
    3. Matsuoka H,
    4. Shimamoto K,
    5. Fujita T,
    6. Shimada K,
    7. Imai Y,
    8. Nishigaki M
    : Valsartan in elderly isolated systolic hypertension (VALISH) study: Rationale and design. Hypertens Res 27: 657–661, 2004
    OpenUrlCrossRefPubMed
  21. ↵
    1. Fried LP,
    2. Tangen CM,
    3. Walston J,
    4. Newman AB,
    5. Hirsch C,
    6. Gottdiener J,
    7. Seeman T,
    8. Tracy R,
    9. Kop WJ,
    10. Burke G,
    11. McBurnie MA
    ; Cardiovascular Health Study Collaborative Research Group: Frailty in older adults: Evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56: M146–M156, 2001
    OpenUrlCrossRefPubMed
  22. ↵
    1. Steinman MA,
    2. Lee SJ,
    3. John Boscardin W,
    4. Miao Y,
    5. Fung KZ,
    6. Moore KL,
    7. Schwartz JB
    : Patterns of multimorbidity in elderly veterans. J Am Geriatr Soc 60: 1872–1880, 2012
    OpenUrlCrossRefPubMed
  23. ↵
    1. Stevens LA,
    2. Li S,
    3. Wang C,
    4. Huang C,
    5. Becker BN,
    6. Bomback AS,
    7. Brown WW,
    8. Burrows NR,
    9. Jurkovitz CT,
    10. McFarlane SI,
    11. Norris KC,
    12. Shlipak M,
    13. Whaley-Connell AT,
    14. Chen SC,
    15. Bakris GL,
    16. McCullough PA
    : Prevalence of CKD and comorbid illness in elderly patients in the United States: Results from the Kidney Early Evaluation Program (KEEP). Am J Kidney Dis 55[Suppl 2]: S23–S33, 2010
    OpenUrlCrossRefPubMed
PreviousNext
Back to top

In this issue

Clinical Journal of the American Society of Nephrology: 11 (5)
Clinical Journal of the American Society of Nephrology
Vol. 11, Issue 5
May 06, 2016
  • Table of Contents
  • Table of Contents (PDF)
  • About the Cover
  • Index by author
View Selected Citations (0)
Print
Download PDF
Sign up for Alerts
Email Article
Thank you for your help in sharing the high-quality science in CJASN.
Enter multiple addresses on separate lines or separate them with commas.
The Continued Quest for Optimal BP Targets in Older Adults with Kidney Disease
(Your Name) has sent you a message from American Society of Nephrology
(Your Name) thought you would like to see the American Society of Nephrology web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
The Continued Quest for Optimal BP Targets in Older Adults with Kidney Disease
Jessica W. Weiss
CJASN May 2016, 11 (5) 753-755; DOI: 10.2215/CJN.03100316

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Request Permissions
Share
The Continued Quest for Optimal BP Targets in Older Adults with Kidney Disease
Jessica W. Weiss
CJASN May 2016, 11 (5) 753-755; DOI: 10.2215/CJN.03100316
del.icio.us logo Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
    • Disclosures
    • Footnotes
    • References
  • Info & Metrics
  • View PDF

More in this TOC Section

  • Telehealth and Kidney Disease Care
  • Time to Abandon Kidney Biopsy to Diagnose Membranous Nephropathy?
  • Should We Let Dialysis Patients Eat Their Fruits and Veggies?
Show more Editorials

Cited By...

  • No citing articles found.
  • Google Scholar

Similar Articles

Related Articles

  • Age and Outcomes Associated with BP in Patients with Incident CKD
  • PubMed
  • Google Scholar

Keywords

  • chronic renal disease
  • blood pressure
  • elderly
  • Adult
  • Blood Pressure Determination
  • humans
  • kidney diseases

Articles

  • Current Issue
  • Early Access
  • Subject Collections
  • Article Archive
  • ASN Meeting Abstracts

Information for Authors

  • Submit a Manuscript
  • Trainee of the Year
  • Author Resources
  • ASN Journal Policies
  • Reuse/Reprint Policy

About

  • CJASN
  • ASN
  • ASN Journals
  • ASN Kidney News

Journal Information

  • About CJASN
  • CJASN Email Alerts
  • CJASN Key Impact Information
  • CJASN Podcasts
  • CJASN RSS Feeds
  • Editorial Board

More Information

  • Advertise
  • ASN Podcasts
  • ASN Publications
  • Become an ASN Member
  • Feedback
  • Follow on Twitter
  • Password/Email Address Changes
  • Subscribe to ASN Journals

© 2022 American Society of Nephrology

Print ISSN - 1555-9041 Online ISSN - 1555-905X

Powered by HighWire