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August 17, 2005

Chronic Kidney Disease and Cardiovascular Risk

JAMA. 2005;294(7):791. doi:10.1001/jama.294.7.791-a

To the Editor: In their study of cardiovascular mortality risk in chronic kidney disease,1 Dr Shlipak and colleagues found that traditional cardiovascular risk factors, including systolic hypertension, had larger associations with cardiovascular mortality than novel risk factors in elderly persons with chronic kidney disease.

The article did not describe the risk associated with diastolic blood pressure or pulse pressure. The importance of this is controversial, with a meta-analysis2 finding pulse pressure unimportant as a risk factor, but other studies3,4 finding pulse pressure to be a more significant risk factor than diastolic or systolic pressure in older persons, especially those with renal impairment.5