In hypertensive subjects, it has been demonstrated that the lower the blood pressure, the lower the incidence of chronic kidney disease (CKD). However, whether this relationship holds true in individuals without hypertension—that is, in individuals with a blood pressure <140/90 mmHg—remains unknown. This study was performed to assess the relationship between blood pressure and CKD in a Japanese population without hypertension. Among 13,007 Japanese participants in a general health screening, 9,596 (5,691 men and 3,905 women) were found to have either normal blood pressure or prehypertension, and were enrolled in this study. We categorized these individuals' blood pressure into six classes: BP-C1, <90/<65 mmHg; BP-C2, 90–100/65–70 mmHg; BP-C3, 100–110/70–75 mmHg; BP-C4, 110–120/75–80 mmHg; BP-C5, 120–130/80–85 mmHg; and BP-C6, 130–140/85–90 mmHg. Albuminuria was defined as a urinary albumin excretion ratio of ≥30 mg/g. Low estimated glomerular filtration rate (eGFR) was defined as eGFR <60 mL/min/1.73 m2. In men, when BP-C3 was used as a reference, multivariate logistic regression analysis adjusted for age, body mass index, serum lipid profiles, fasting plasma glucose and smoking status showed that BP-C1, BP-C2, BP-C4, BP-C5 and BP-C6 were associated with albuminuria with an adjusted odds ratio of 1.85 (0.53–6.46), 1.22 (0.59–2.51), 1.62 (1.01–2.59), 2.57 (1.64–4.02), and 3.81 (2.44–5.96). In women, the adjusted odds ratios of the risk for albuminuria in BP-C2, BP-C3, BP-C4, BP-C5 and BP-C6, as compared with BP-C1 as a reference, were 1.83 (0.70–4.79), 2.13 (0.84–5.42), 2.80 (1.10–7.14), 2.59 (0.99–6.78), and 3.99 (1.50–10.64). Blood pressure was not significantly associated with low eGFR in either gender. The risk for albuminuria was significantly greater when blood pressure exceeded 110/75 mmHg in both genders.
National Kidney Foundation : K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification. Am J Kidney Dis 2002; 39: S1–S266.
Klag MJ, Whelton PK, Randall BL, et al: Blood pressure and end-stage renal disease in men. N Engl J Med 1996; 334: 13–18.
Yamagata K, Ishida K, Sairenchi T, et al: Risk factors for chronic kidney disease in a community-based population: a 10-year follow-up study. Kidney Int 2007; 71: 159–166.
Ramirez SP, McClellan W, Port FK, Hsu SI : Risk factors for proteinuria in a large, multiracial, southeast Asian population. J Am Soc Nephrol 2002; 13: 1907–1917.
Cirillo M, Senigalliesi L, Laurenzi M, et al: Microalbuminuria in nondiabetic adults: relation of blood pressure, body mass index, plasma cholesterol levels, and smoking: the Gubbio Population Study. Arch Intern Med 1998; 158: 1933–1939.
Lewington S, Clarke R, Qizilbash N, Peto R, Collins R : Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002; 360: 1903–1913.
Hansson L, Zanchetti A, Carruthers SG, et al, HOT Study Group: Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. Lancet 1998; 351: 1755–1762.
Arima H, Chalmers J, Woodward M, et al: Lower target blood pressures are safe and effective for the prevention of recurrent stroke: the PROGRESS trial. J Hypertens 2006; 24: 1201–1208.
ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group: Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002; 288: 2981–2997.
Haroun MK, Jaar BG, Hoffman SC, Comstock GW, Klag MJ, Coresh J : Risk factors for chronic kidney disease: a prospective study of 23,534 men and women in Washington County, Maryland. J Am Soc Nephrol 2003; 14: 2934–2941.
Imai E, Horio M, Nitta K, et al: Estimation of glomerular filtration rate by the MDRD study equation modified for Japanese patients with chronic kidney disease. Clin Exp Nephrol 2007; 11: 41–50.
Culleton BF, Larson MG, Parfrey PS, Kannel WB, Levy D : Proteinuria as a risk factor for cardiovascular disease and mortality in older people: a prospective study. Am J Med 2000; 109: 1–8.
Grimm RH Jr, Svendsen KH, Kasiske B, Keane WF, Wahi MM : Proteinuria is a risk factor for mortality over 10 years of follow-up. MRFIT Research Group. Multiple Risk Factor Intervention Trial. Kidney Int Suppl 1997; 63: S10–S14.
Iseki K, Ikemiya Y, Iseki C, Takishita S : Proteinuria and the risk of developing end-stage renal disease. Kidney Int 2003; 63: 1468–1474.
Tozawa M, Iseki K, Iseki C, Kinjo K, Ikemiya Y, Takishita S : Blood pressure predicts risk of developing end-stage renal disease in men and women. Hypertension 2003; 41: 1341–1345.
Reckelhoff JF : Gender differences in the regulation of blood pressure. Hypertension 2001; 37: 1199–1208.
Pitt B, Remme W, Zannad F, et al: Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med 2003; 348: 1309–1321.
Aldigier JC, Kanjanbuch T, Ma LJ, Brown NJ, Fogo AB : Regression of existing glomerulosclerosis by inhibition of aldosterone. J Am Soc Nephrol 2005; 16: 3306–3314.
Rocha R, Chander PN, Khanna K, Zuckerman A, Stier CT Jr : Mineralocorticoid blockade reduces vascular injury in stroke-prone hypertensive rats. Hypertension 1998; 31: 451–458.
Nagase M, Shibata S, Yoshida S, Nagase T, Gotoda T, Fujita T : Podocyte injury underlies the glomerulopathy of Dahl salt-hypertensive rats and is reversed by aldosterone blocker. Hypertension 2006; 47: 1084–1093.
Del Vecchio L, Procaccio M, Vigano S, Cusi D : Mechanisms of disease: the role of aldosterone in kidney damage and clinical benefits of its blockade. Nat Clin Pract Nephrol 2007; 3: 42–49.
Tozawa M, Iseki K, Iseki C, Oshiro S, Ikemiya Y, Takishita S : Influence of smoking and obesity on the development of proteinuria. Kidney Int 2002; 62: 956–962.
Mattix HJ, Hsu CY, Shaykevich S, Curhan G : Use of the albumin/creatinine ratio to detect microalbuminuria: implications of sex and race. J Am Soc Nephrol 2002; 13: 1034–1039.
Warram JH, Gearin G, Laffel L, Krolewski AS : Effect of duration of type I diabetes on the prevalence of stages of diabetic nephropathy defined by urinary albumin/creatinine ratio. J Am Soc Nephrol 1996; 7: 930–937.
Connell SJ, Hollis S, Tieszen KL, McMurray JR, Dornan TL : Gender and the clinical usefulness of the albumin: creatinine ratio. Diabet Med 1994; 11: 32–36.
Bakris GL, Williams M, Dworkin L, et al: Preserving renal function in adults with hypertension and diabetes: a consensus approach. National Kidney Foundation Hypertension and Diabetes Executive Committees Working Group. Am J Kidney Dis 2000; 36: 646–661.
About this article
Cite this article
Higashikuni, Y., Ishizaka, N., Ishizaka, Y. et al. Relationship between Blood Pressure and Chronic Kidney Disease in the Japanese Population: The Lower the Better Even in Individuals without Hypertension?. Hypertens Res 31, 213–219 (2008). https://doi.org/10.1291/hypres.31.213
- blood pressure
- chronic kidney disease
- Japanese population