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Usefulness of the blood pressure classification in the new 2017 ACC/AHA hypertension guidelines for the prediction of new-onset chronic kidney disease

Journal of Human Hypertension volume 33, pages 873–878 (2019)Cite this article

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Abstract

The aim of this study was to determine whether the blood pressure (BP) classification recommended in the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) hypertension guidelines is useful for the prediction of chronic kidney disease (CKD) in adults. We conducted a retrospective cohort study using annual health check data in Iki City, Nagasaki, Japan. A total of 3269 adults without CKD, who were not on BP-lowering medication, were included in the present analysis. BP was classified as: normal (systolic BP (SBP) <120 mmHg and diastolic BP (DBP) <80 mmHg), elevated BP (120 ≤ SBP < 130 and/or DBP < 80), stage 1 hypertension (130 ≤ SBP < 140 and/or 80 ≤ DBP < 90), and stage 2 hypertension (SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg). The primary outcome of the study was new-onset CKD. The effects of BP on the development of CKD were evaluated using Cox’s proportional hazards modelling. During a mean follow-up of 4.8 years, 472 (14.4%) participants developed CKD. The incidence (per 1000 person-years) of new-onset CKD was higher in individuals with elevated BP. After adjustment for other risk factors, there were significant associations between elevated BP and new-onset CKD: hazard ratio 1.11 (95% confidence interval 0.87–1.42) in elevated BP, 1.25 (1.01–1.54) in stage 1 hypertension, and 1.45 (1.18–1.79) in stage 2 hypertension, compared with the reference group with normal BP (P < 0.001 for trend). Thus, the findings of this study confirm the definition of hypertension (≥130/80 mmHg) recommended by the 2017 ACC/AHA guidelines for the management of hypertension to be useful for the prediction of new-onset CKD.

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Acknowledgements

We thank Mark Cleasby, PhD, from Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript.

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Authors and Affiliations

  1. Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan

    Toshiki Maeda, Chikara Yoshimura & Hisatomi Arima

  2. Department of Internal Medicine, Nagasaki Prefecture Iki Hospital, Iki, Japan

    Koji Takahashi & Shigeaki Mukoubara

  3. Department of Internal Medicine, Division of Nephrology and Rheumatology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan

    Kenji Ito, Tetsuhiko Yasuno, Kousuke Masutani & Hitoshi Nakashima

  4. Department of Internal Medicine, Division of Nephrology and Rheumatology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan

    Yasuhiro Abe

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  1. Toshiki Maeda
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Maeda, T., Yoshimura, C., Takahashi, K. et al. Usefulness of the blood pressure classification in the new 2017 ACC/AHA hypertension guidelines for the prediction of new-onset chronic kidney disease. J Hum Hypertens 33, 873–878 (2019). https://doi.org/10.1038/s41371-019-0198-7

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