Division of Endocrinology, Gangnam Severance Hospital, College of Medicine, Yonsei University, Seoul, South Korea.
Department of Internal Medicine, Gangnam Severance Hospital, College of Medicine, Yonsei University, Seoul, South Korea.
Am J Kidney Dis. 2024 Dec;84(6):675-685.e1. doi: 10.1053/j.ajkd.2024.05.015. Epub 2024 Jul 30.
RATIONALE & OBJECTIVE: The association of long-term cumulative blood pressure (BP) loads with the risk of incident chronic kidney disease (CKD) remains a matter of debate. This study investigated this association among healthy Korean adults with normal kidney function.
Prospective cohort study.
SETTING & PARTICIPANTS: We analyzed 5,221 participants without CKD in the Korean Genome and Epidemiology Study. Cumulative systolic and diastolic BP (SBP and DBP) loads were calculated as the ratios of the areas under the curve (AUC) for SBP≥120mm Hg or≥80mm Hg for DBP divided by the AUC for all SBP or DBP measurements during the exposure period. These AUCs were categorized into 4 groups: group 0 (reference), cumulative BP load of 0 and groups 1-3, tertiles of cumulative BP loads.
Primary end point was incident CKD defined as a composite of an estimated glomerular filtration rate (eGFR) below 60mL/min/1.73m or proteinuria greater than 1+on dipstick examination for at least 2 consecutive measurements≥90 days apart.
Multivariable Cox proportional hazards regression to estimate the independent association of cumulative BP loads with incident CKD.
Higher cumulative SBP and DBP loads were associated with an increased risk of incident CKD (HR, 1.23 [95% CI, 1.12-1.35] for SBP; and HR, 1.14 [95% CI, 1.04-1.26] for DBP loads for each 1.0-unit greater load). Compared with SBP group 0, groups 2 and 3 were associated with 1.94- and 1.89-fold greater risk of incident CKD. Compared with DBP group 0, groups 2 and 3 were associated with 1.42- and 1.54-fold greater risks. These associations of high cumulative BP loads with an increased risk of incident CKD remained consistent even in the subgroups not taking antihypertensive agents or without prior hypertension diagnosis.
The assessment of CKD outcomes relied on eGFR and spot urine tests.
These findings highlight the association between high cumulative SBP and DBP loads and the occurrence of CKD, even in individuals with normal BP levels.
PLAIN-LANGUAGE SUMMARY: Although hypertension is a major risk factor for chronic kidney disease (CKD), most studies have focused on single-point blood pressure (BP) measurements. To explore the association between long-term cumulative BP load and the development of CKD, 5,221 Korean adults with normal kidney function were included in this study. Cumulative systolic BP and diastolic BP load both exhibited a significant association with an increased risk of incident CKD. Notably, the association of cumulative BP loads with elevated risk of incident CKD was evident also in individuals who were not taking antihypertensive agents or who had no previous history of hypertension. These findings underscore the importance of managing long-term exposure to high BP, even in individuals with normal BP levels.
长期累积血压（BP）负荷与慢性肾脏病（CKD）事件风险之间的关联仍存在争议。本研究旨在调查肾功能正常的韩国健康成年人中这种关联。
前瞻性队列研究。
我们分析了韩国基因与流行病学研究中无 CKD 的 5221 名参与者。累积收缩压和舒张压（SBP 和 DBP）负荷计算为 SBP≥120mmHg 或 DBP≥80mmHg 的曲线下面积（AUC）与暴露期间所有 SBP 或 DBP 测量的 AUC 之比。这些 AUC 分为 4 组：第 0 组（参考）、0 累积 BP 负荷和第 1-3 组，累积 BP 负荷的三分位数。
首发 CKD 定义为估算肾小球滤过率（eGFR）<60mL/min/1.73m 或蛋白尿>1+，至少连续 2 次检测≥90 天，相隔≥90 天。
多变量 Cox 比例风险回归估计累积 BP 负荷与首发 CKD 之间的独立关联。
较高的累积 SBP 和 DBP 负荷与首发 CKD 风险增加相关（SBP 每增加 1.0 单位，HR 为 1.23[95%CI，1.12-1.35]；DBP 负荷为 1.14[95%CI，1.04-1.26]）。与 SBP 第 0 组相比，第 2 组和第 3 组发生首发 CKD 的风险分别增加 1.94 倍和 1.89 倍。与 DBP 第 0 组相比，第 2 组和第 3 组发生首发 CKD 的风险分别增加 1.42 倍和 1.54 倍。即使在未服用抗高血压药物或无既往高血压诊断的亚组中，高累积 BP 负荷与首发 CKD 风险增加的这些关联仍然一致。
CKD 结局的评估依赖于 eGFR 和尿液检测。
这些发现突出了高累积 SBP 和 DBP 负荷与 CKD 发生之间的关联，即使在血压水平正常的个体中也是如此。
尽管高血压是慢性肾脏病（CKD）的主要危险因素，但大多数研究都集中在单点血压（BP）测量上。为了探讨长期累积 BP 负荷与 CKD 发展之间的关系，纳入了 5221 名肾功能正常的韩国成年人。累积收缩压和舒张压负荷均与首发 CKD 风险增加显著相关。值得注意的是，累积 BP 负荷与首发 CKD 风险增加的关联在未服用抗高血压药物或无既往高血压病史的人群中也有体现。这些发现强调了即使在血压水平正常的个体中，管理长期暴露于高血压的重要性。
