{"id":"1a61481e773c","type":"article","url":"https://hartvaat.nl/2017/02/01/reverse-causality-in-de-associatie-bloeddruk-cardiovasculair-risico-bij-ckd/","title":"Reverse causality in de associatie bloeddruk-cardiovasculair risico bij CKD","title_en":"Evidence for Reverse Causality in the Association Between Blood Pressure and Cardiovascular Risk in Patients With Chronic Kidney Disease.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","anemie-ckd","biomarkers-cardiovasculair","secundaire-preventie"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.116.08386","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.116.08386","authors":["William Herrington","Natalie Staplin","Parminder K Judge","Marion Mafham","Jonathan Emberson","Richard Haynes","David C Wheeler","Robert Walker","Charlie Tomson","Larry Agodoa","Andrzej Wiecek","Sarah Lewington","Christina A Reith","Martin J Landray","Colin Baigent"],"significance":6,"published":"2017-02-01","source_date":"2017-02-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/","https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/"],"congress":"","summary_en":"This study provided evidence for reverse causality in the association between low blood pressure and adverse cardiovascular outcomes in advanced CKD, suggesting that the J-curve in this population reflects sicker patients rather than a treatment hazard.","created":"2026-07-03T10:26:32Z","updated":"2026-07-03T13:25:51Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die bewijs levert voor reverse causality (omgekeerde oorzakelijkheid) in het verband tussen bloeddruk en cardiovasculair risico bij chronische nierziekte. Methodologisch belangrijk voor de interpretatie van observationele data.","abstract_original":"UNLABELLED: Among those with moderate-to-advanced chronic kidney disease, the relationship between blood pressure (BP) and cardiovascular disease seems U shaped but is loglinear in apparently healthy adults. The SHARP (Study of Heart and Renal Protection) randomized 9270 patients with chronic kidney disease to ezetimibe/simvastatin versus matching placebo and measured BP at each follow-up visit. Cox regression was used to assess the association between BP and risk of cardiovascular disease among (1) those with a self-reported history of cardiovascular disease and (2) those with no such history and, based on plasma troponin-I concentration, a low probability of subclinical cardiac disease. A total of 8666 participants had a valid baseline BP and troponin-I measurement, and 2188 had at least 1 cardiovascular event during follow-up. After adjustment for relevant confounders, the association between systolic BP and cardiovascular events was U shaped, but among participants without evidence of previous cardiovascular disease, there was a positive loglinear association throughout the range of values studied. Among those with the lowest probability of subclinical cardiac disease, each 10 mm Hg higher systolic BP corresponded to a 27% increased risk of cardiovascular disease (hazard ratio, 1.27; 95% confidence interval, 1.11-1.44). In contrast, the relationship between diastolic BP and cardiovascular risk remained U shaped irrespective of cardiovascular disease history or risk of subclinical disease. In conclusion, the lack of a clear association between systolic BP and cardiovascular risk in this population seems attributable to confounding, suggesting that more intensive systolic BP reduction may be beneficial in such patients. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00125593."}