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Association of achieved blood pressure after treatment for primary aldosteronism with long-term kidney function

Journal of Human Hypertension volume 36, pages 904–910 (2022)Cite this article

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Abstract

Little is known regarding the association of blood pressure (BP) after treatment for primary aldosteronism (PA) (i.e., adrenalectomy and mineralocorticoid receptor antagonists) with long-term renal outcomes, and whether the association is independent of BP before treatment. Using a dataset from a nationwide registry of PA in Japan, we assessed whether achieved BP levels 6 months after treatment for PA are associated with annual changes in estimated glomerular filtration rate (eGFR), rapid eGFR decline, and incident chronic kidney disease (CKD) during the 5-year follow-up period. The cohort included 1266 PA patients. In multivariable linear regression including systolic BP (SBP) levels before treatment for PA, estimates (95% confidence interval [CI]) for annual changes in eGFR after month 6 associated with one-standard deviation (1-SD) higher SBP at month 6 were –0.08 (–0.15, –0.02) mL/min/1.73 m2/year. After multivariable adjustment, the estimate (95% CI) for annual changes in eGFR after month 6 was –0.12 (–0.21, –0.02) for SBP ≥ 130 mmHg vs. SBP < 130 mmHg at month 6. Among 537 participants without CKD at baseline, a 1-SD higher SBP was associated with a higher risk for incident CKD events (hazard ratio [95% CI]: 1.40 [1.00, 1.94]). Higher SBP after treatment for PA was associated with a higher risk for kidney dysfunction over time, independently of BP levels before treatment. Achieving SBP lower than 130 mmHg after treatment for PA may be linked to better kidney outcomes.

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Acknowledgements

We thank the JPAS/JRAS members for collecting the clinical data.

Funding

This study was conducted as a part of the JPAS and JRAS by a research grant from the Japan Agency for Medical Research and Development (grant numbers JP17ek0109122 and JP20ek0109352), and the National Center for Global Health and Medicine, Japan (27-1402, 30-1008).

Author information

Authors and Affiliations

  1. Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan

    Tatsuya Haze & Kouichi Tamura

  2. Division of Nephrology and Hypertension, Yokohama City University Medical Center, Yokohama, Japan

    Tatsuya Haze & Kouichi Tamura

  3. Center for Novel and Exploratory Clinical Trials, Yokohama City University, Yokohama, Japan

    Yuichiro Yano

  4. Department of Community and Family Medicine, Duke University, Durham, North Carolina, USA

    Yuichiro Yano & Yu Hatano

  5. Department of Endocrinology, Metabolism and Nephrology, School of Medicine Keio University, Tokyo, Japan

    Isao Kurihara

  6. Department of Medical Education, National Defense Medical College, Tokorozawa, Japan

    Isao Kurihara

  7. Division of Nephrology, Hypertension, and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan

    Hiroki Kobayashi

  8. Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto, Japan

    Mika Tsuiki

  9. Department of Diabetes and Endocrinology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan

    Takamasa Ichijo

  10. Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo, Japan

    Norio Wada

  11. Division of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital, Yokohama, Japan

    Takuyuki Katabami

  12. Department of Geriatric and General Medicine, Osaka University, Osaka, Japan

    Koichi Yamamoto

  13. Department of Endocrinology, Tenri Hospital, Tenri, Japan

    Shintaro Okamura

  14. Department of Cardiology, Saiseikai Tondabayashi Hospital, Tondabayashi, Japan

    Tatsuya Kai

  15. Division of Endocrinology and Metabolism, Tottori University Faculty of Medicine, Yonago, Japan

    Shoichiro Izawa

  16. Department of Endocrinology and Diabetes Mellitus, Misato Kenwa Hospital, Misato, Japan

    Yuichiro Yoshikawa

  17. Division of Endocrinology and Metabolism, Department of Internal Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan

    Masanobu Yamada

  18. Endovascular Treatment Group, Mito Saiseikai General Hospital, Mito, Japan

    Yoshiro Chiba

  19. Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine, Tokyo, Japan

    Akiyo Tanabe

  20. Clinical Research Institute of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto, Japan

    Mitsuhide Naruse

  21. Endocrine Center and Clinical Research Center, Ijinkai Takeda General Hospital, Kyoto, Japan

    Mitsuhide Naruse

Authors
  1. Tatsuya Haze
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  2. Yuichiro Yano
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  8. Takamasa Ichijo
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  9. Norio Wada
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  14. Shoichiro Izawa
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  15. Yuichiro Yoshikawa
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  19. Mitsuhide Naruse
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Consortia

JPAS/JRAS Study Group

  • Tatsuya Haze
  • , Yuichiro Yano
  • , Yu Hatano
  • , Kouichi Tamura
  • , Isao Kurihara
  • , Hiroki Kobayashi
  • , Mika Tsuiki
  • , Takamasa Ichijo
  • , Norio Wada
  • , Takuyuki Katabami
  • , Koichi Yamamoto
  • , Shintaro Okamura
  • , Tatsuya Kai
  • , Shoichiro Izawa
  • , Yuichiro Yoshikawa
  • , Masanobu Yamada
  • , Yoshiro Chiba
  • , Akiyo Tanabe
  •  & Mitsuhide Naruse

Contributions

TH, Y. Yano, KT and MN designed the study; TH carried out the analyses; TH and Y. Yano drafted the manuscript; and YH, KT, IK, HK, MT, TI, NW, T. Katabami, KY, SO, T. Kai, SI, Y. Yoshikawa, MY, YC, AT and MN revised the paper.

Corresponding authors

Correspondence to Yuichiro Yano or Kouichi Tamura.

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The authors declare no competing interests.

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Haze, T., Yano, Y., Hatano, Y. et al. Association of achieved blood pressure after treatment for primary aldosteronism with long-term kidney function. J Hum Hypertens 36, 904–910 (2022). https://doi.org/10.1038/s41371-021-00595-4

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