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Thomas V. Perneger, MD, MPH; Michael J. Klag, MD, MPH; Javier Nieto, MD, PhD; Moyses Szklo, MD, DrPH; Paul K. Whelton, MD, MSc
The Johns Hopkins University School of Hygiene and Public Health Baltimore, Md

JAMA. 1993;269(23):2984.

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—The comments of Rosansky, Salive, and Havlik provide support for our finding that blood pressure levels in the normal range are associated with serum creatinine levels. Rosansky et al¹ were indeed the first to report an association between average blood pressure levels and change in serum creatinine level. In this respect, their study provided an even stronger argument for a causal association than ours. However, their finding was obtained in a group of 115 patients discharged from a Veterans Administration hospital, not in the general population. Hospital patients may suffer from systemic diseases or may be exposed to nephrotoxic substances, such as analgesics, antibiotics, or radiological contrast media, that can harm the kidneys, potentially creating an artifactual association between change in serum creatinine and blood pressure levels. Similarly, a progressive association between average blood pressure in the normal range and change in renal function was recently reported . . . [Full Text PDF of this Article]

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