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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.

Table appears in full text version. Table. Comparison of . . . [Full Text of this Article]

Michael G. Shlipak, MD, MPH
shlip@itsa.ucsf.edu
General Internal Medicine Section
VA Medical Center
San Francisco, Calif

Ronit Katz, PhD
Collaborative Health Studies Coordinating Center
Seattle, Wash

Linda F. Fried, MD, MPH
Renal Section, Medical Service
VA Pittsburgh Healthcare System
Pittsburgh, Pa

Anne B. Newman, MD, MPH
Department of Epidemiology
University of Pittsburgh Graduate School of Public Health
Pittsburgh, Pa

David S. Siscovick, MD, MPH; Bruce Psaty, MD, PhD
Cardiovascular Health Research Unit
University of Washington
Seattle

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