Systolic Blood Pressure and Mortality Among Veterans Following AKI: TH-PO062

Benjamin R. Griffin; Masaaki Yamada; Meenakshi Sambharia; Melissa L. Swee; Heather Reisinger; Diana I. Jalal

doi:10.1681/ASN.20223311S166c

Background: Acute kidney injury (AKI) complicates 20-25% of hospitalizations and is associated with increased long-term mortality. Recommended target blood pressures (BP) have been reduced in the last 5 years, but whether lower targets should be applied in the post-AKI population is unknown. We evaluated the impact of different systolic BP (SBP) categories on mortality among post-AKI Veterans. Methods: In this retrospective cohort analysis, we included all adult VA patients admitted from 2013 to 2018 with in-hospital AKI who were discharged alive and had at least 1 blood pressure within 30 days of discharge. SBP was assessed for up to 2 years after discharge and categorized as 100-120, 120-130, and >130 mmHg (SBP<100 mmHg were excluded). The primary outcome was 2-year mortality. We used Cox Proportional Hazards regression to adjust for baseline age, race, sex, chronic lung disease, unexplained weight loss, dementia, congestive heart failure (CHF), hematocrit, blood urea nitrogen, bilirubin, and albumin, while allowing SBP to vary over the follow-up period. Because angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) are associated with decreased mortality, we stratified the analysis based on whether the patient was on an ACEI/ARB within 90 days of discharge. Results: A total of 97,376 patients met inclusion criteria, of which 25,600 (26%) died within 2 years of discharge. The cohort had high rates of hypertension (85%), CHF (28%), and diabetes mellitus (19%). Within 30 days of discharge, 32%, 25%, and 43% had SBP <120, 120-130, or >130, respectively. Compared to follow-up months with SBP >130 mmHg, SBP 120-130 and < 120 mmHg had adjusted hazard ratios (HR) for mortality of 0.870 (95% CI 0.865-0.876) and 0.968 (95% CI 0.964-0.971), respectively. Within 90 days, 41,147 (42%) were treated with ACEI/ARB, and these patients had 20.6% 2-year mortality compared to 30.5% in those not treated with ACEI/ARB (unadjusted OR 0.59 (95% CI 0.57-0.61)). When stratified for ACEI/ARB use, HRs for SBP 100-120 and 120-130, relative to SBP>130 were similar to the full cohort. Conclusions: In a post-AKI cohort, SBP of 120-130 mmHg was associated with a lower HR for 2-year mortality than 100-120 mmHg, and both were superior to >130 mmHg. This association was independent of the use of ACEI/ARB.

Systolic Blood Pressure and Mortality Among Veterans Following AKI: TH-PO062

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