Range in systolic blood pressure and care-needs certification in long-term care insurance in community-dwelling older patients with chronic kidney disease

• Published in: Journal of international medical research Vol. 46; no. 1; pp. 293 - 306
• Main Authors: Himeno, Taroh, Okuno, Tazuo, Watanabe, Keisuke, Nakajima, Kumie, Iritani, Osamu, Yano, Hiroshi, Morita, Takuro, Igarashi, Yuta, Okuro, Masashi, Morimoto, Shigeto
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.01.2018; Sage Publications Ltd; SAGE Publishing
• Subjects: Aged; Aged, 80 and over; Blood Pressure; Certification; Cohort Studies; Dementia; Dementia - diagnosis; Dementia - economics; Dementia - mortality; Dementia - physiopathology; Female; Glomerular Filtration Rate; Humans; Hypertension - diagnosis; Hypertension - economics; Hypertension - mortality; Hypertension - physiopathology; Independent Living; Insurance, Long-Term Care - statistics & numerical data; Kidney diseases; Long term care insurance; Long term health care; Male; Proportional Hazards Models; Renal Insufficiency, Chronic - diagnosis; Renal Insufficiency, Chronic - economics; Renal Insufficiency, Chronic - mortality; Renal Insufficiency, Chronic - physiopathology; Research Report; long-term care insurance; older patients; dementia; chronic kidney disease; Blood pressure; certification
• ISSN: 0300-0605; 1473-2300
• DOI: 10.1177/0300060517721795

Objective Low systolic blood pressure (SBP) is associated with an increased risk for cardiovascular morbidity/mortality in older patients with chronic kidney disease (CKD). The present study evaluated the association between range in blood pressure and first care-needs certification in the Long-term Care Insurance (LTCI) system or death in community-dwelling older subjects with or without CKD. Methods CKD was defined as an estimated glomerular filtration rate <60 ml/min/1.73 m2 or dipstick proteinuria of + or greater. Our study was conducted in 1078 older subjects aged 65–94 years. Associations were estimated using the Cox proportional hazards model. Results During 5 years of follow-up, 135 first certifications and 53 deaths occurred. Among patients with CKD, moderate SBP (130–159 mmHg) was associated with a significantly lower adjusted risk of subsequent total certification (hazard ratio [HR] = 0.44) and subsequent certification owing to dementia (HR = 0.17) compared with SBP < 130 mmHg. These relationships were not observed in non-CKD subjects. Conclusion Lower SBP of <130 mmHg may predict a higher risk for subsequent first care-needs certification in LTCI, especially for dementia, in community-dwelling patients with CKD.