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August 17, 2005

Chronic Kidney Disease and Cardiovascular Risk—Reply

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

In Reply: Drs O’Rourke and Safar raise the question of the relative importance of systolic blood pressure and pulse pressure as predictors of cardiovascular mortality in the setting of chronic kidney disease. Using the data from our study, we analyzed the 3 blood pressure parameters as linear variables (Table), choosing their respective SDs as the increments for analysis. Systolic blood pressure was at least as strong a predictor as pulse pressure, for it remained significantly associated with cardiovascular mortality even after adjustment for pulse pressure or diastolic blood pressure. These findings were similar in participants with or without chronic kidney disease. Our findings differ from those reported by Klassen et al1 in their cohort of patients on hemodialysis. We conclude that our evidence does not support the categorization of pulse pressure as a novel cardiovascular risk factor in elderly persons with moderate chronic kidney disease.