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

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 m(2) 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.