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Impact of continued high blood pressure on the progression of diabetic nephropathy after 10 years: KAMOGAWA-HBP study

Hypertension Research volume 46, pages 565–574 (2023)Cite this article

Abstract

Albuminuria is a prognostic marker of worsening renal outcomes in people with hypertension and type 2 diabetes. High home systolic blood pressure is associated with the development of diabetic nephropathy. We assessed the impact of chronic high home blood pressure on diabetic nephropathy progression 10 years after study entry. The participants measured their blood pressure three times in the morning for 14 days at study entry and 10 years after study entry. A retrospective cohort of 165 people with type 2 diabetes at a single hospital was classified into four groups (good control maintenance, improvement, deterioration, and continuous high blood pressure groups) according to a morning home systolic blood pressure ≥125 mmHg at study entry and 10 years after study entry. Logistic regression analysis was performed to determine the association between home blood pressure control and the progression of diabetic nephropathy. After 10 years of entry, the status of nephropathy improved for 5.5% of the participants, remained unchanged for 72.1%, and progressed for 22.4%. The odds ratio of the continuous high blood pressure group versus that of the good control maintenance group for the progression of diabetic nephropathy was 10.41 (95% CI, 1.26–86.15). After adjusting for the introduction of renin-angiotensin-aldosterone system inhibitors during the follow-up period, there was no significant difference in the odds ratio of worsening nephropathy between these groups. The deterioration and improvement groups did not have significant diabetic nephropathy progression compared to the good control maintenance group. Chronic high home blood pressure was associated with the progression of diabetic nephropathy, and RAAS inhibitors could attenuate the negative effect.

We demonstrated that chronic home blood pressure was associated with the progression of diabetic nephropathy.

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Acknowledgements

We thank Dr. Atsushi Omoto and Dr. Wataru Fukuda at Kyoto First Red Cross Hospital and Dr. Shinichi Mogami and Dr. Yoshihiro Kitagawa at Osaka General Hospital of West Japan Railway Company for their assistance in collecting data. We are grateful to Sayoko Tanaka at the Kyoto Prefectural University of Medicine for her secretarial assistance and Naoko Higo, Terumi Kaneko, and Machiko Hasegawa at the Kyoto Prefectural University of Medicine for instructing the study participants on how to measure their BP. We are grateful to Editage (www.editage.com) for English language editing.

Funding

EU received grant support from the Japanese Study Group for Physiology and Management of Blood Pressure, the Astellas Foundation for Research on Metabolic Disorders (Grant number: 4024), and the Mishima Kaiun Memorial Foundation. Names of grants: The Japanese Study Group for Physiology and Management of Blood Pressure, the Astellas Foundation for Research on Metabolic Disorders, and the Mishima Kaiun Memorial Foundation.

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Authors and Affiliations

  1. Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan

    Shinnosuke Hata, Emi Ushigome, Yukako Hosomi, Takashi Yoshimura, Maya Takegami, Nobuko Kitagawa, Masahide Hamaguchi & Michiaki Fukui

  2. Department of Endocrinology and Metabolism, Kyoto First Red Cross Hospital, Kyoto, Japan

    Toru Tanaka & Mai Asano

  3. Department of Endocrinology and Metabolism, Kyoto Second Red Cross Hospital, Kyoto, Japan

    Goji Hasegawa & Masahiro Yamazaki

  4. Department of Endocrinology and Metabolism, Osaka General Hospital of West Japan Railway Company, Osaka, Japan

    Masayoshi Ohnishi

  5. Department of Cardiology, Nishijin Hospital, Kyoto, Japan

    Sei Tsunoda

  6. Department of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan

    Hidetaka Ushigome

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  1. Shinnosuke Hata
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Conflict of interest

SH reports personal fees from Kowa Pharmaceutical Company Ltd., outside the submitted work. EU received grant support from the Japan Society for the Promotion of Science and received personal fees from Nippon Boehringer Ingelheim Co., Ltd., Mitsubishi Tanabe Pharma Corporation, Daiichi Sankyo Company, Limited, Takeda Pharmaceutical Company Ltd., MSD K.K., Kyowa Hakko Kirin Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd., Kowa Pharmaceutical Co., Ltd., Novo Nordisk Pharma Ltd., Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., AstraZeneca K.K., and Sanofi K.K., outside the submitted work. The donated fund laboratory of diabetes therapeutics is an endowment department supported by an unrestricted grant from Ono Pharmaceutical Co., Ltd., Taiyo Kagaku Co., Ltd. and Taisho Pharmaceutical Co., Ltd. TY reports personal fees from Sumitomo Dainippon Pharma Co., Ltd., outside the submitted work. Isao Yokota reports grants from Kakenhi, Amed, and Health, Labor and Welfare Policy Research Grants, research funding by Nihon Medi-Physics, and speaker fees from Chugai Pharmaceutical Co, AstraZeneca plt, Japan Tobacco Pharmaceutical Division, and Nippon Shinyaku Co., outside the submitted work. MA received personal fees from Takeda Pharmaceutical Co., Ltd., Abbott Japan Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd., Kowa Pharmaceutical Co., Ltd., Novo Nordisk Pharma Ltd., Ono Pharmaceutical Co., Ltd., AstraZeneca K.K., and Chugai Pharmaceutical Co., Ltd., outside the submitted work. MH received grants from AstraZeneca K.K., Ono Pharma Co. Ltd., Oishi Kenko Inc., Yamada Bee Farm, Nippon Boehringer Ingelheim Co. Ltd., and received personal fees from AstraZeneca K.K., Ono Pharma Co. Ltd., Eli Lilly, Japan, Sumitomo Dainippon Pharma Co., Ltd., Daiichi Sankyo Co. Ltd., Mitsubishi Tanabe Pharma Corp., Sanofi K.K., Kowa Pharma Co. Ltd., outside the submitted work. MY reports personal fees from MSD K.K., personal fees from Sumitomo Dainippon Pharma Co., Ltd.; personal fees from Kowa Company, Limited; personal fees from AstraZeneca PLC; personal fees from Takeda Pharmaceutical Company Limited; personal fees from Kyowa Hakko Kirin Co., Ltd.; personal fees from Daiichi Sankyo Company, Limited; personal fees from Kowa Pharmaceutical Company Ltd.; and personal fees from Ono Pharmaceutical Co., LTD., outside the submitted work. Michiaki Fukui received grants from Ono Pharma Co. Ltd., Oishi Kenko Inc., Yamada Bee Farm, Nippon Boehringer Ingelheim Co. Ltd., Kissei Pharma Co. Ltd., Mitsubishi Tanabe Pharma Corp., Daiichi Sankyo Co. Ltd., Sanofi K.K., Takeda Pharma Co. Ltd., Astellas Pharma Inc., MSD K.K., Kyowa Kirin Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd., Kowa Pharma Co. Ltd., Novo Nordisk Pharma Ltd., Sanwa Kagagu Kenkyusho CO., Ltd., Eli Lilly, Japan, K.K., Taisho Pharma Co., Ltd., Terumo Corp., Tejin Pharma Ltd., Nippon Chemiphar Co., Ltd., Abbott Japan Co. Ltd., and Johnson & Johnson K.K. Medical Co., Terumo Corporation, and received personal fees from Nippon Boehringer Ingelheim Co., Ltd., Kissei Pharma Co., Ltd., Mitsubishi Tanabe Pharma Corp., Daiichi Sankyo Co. Ltd., Sanofi K.K., Takeda Pharma Co. Ltd., Astellas Pharma Inc., MSD K.K., Kyowa Kirin Co. Ltd., Sumitomo Dainippon Pharma Co. Ltd., Kowa Pharma Co. Ltd., Novo Nordisk Pharma Ltd., Ono Pharma Co. Ltd., Sanwa Kagaku Kenkyusho Co. Ltd., Eli Lilly Japan K.K., Taisho Pharma Co., Ltd., Bayer Yakuhin, Ltd., AstraZeneca K.K., Mochida Pharma Co. Ltd., Abbott Japan Co. Ltd., Teijin Pharma Ltd., Arkray Inc., Medtronic Japan Co. Ltd., and Nipro Corp., Terumo Corporation, outside the submitted work. The sponsors were not involved in the study design, collection, analysis, or interpretation of the data; the writing of this manuscript; or the decision to submit the article for publication. The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article. The authors declare that although they are affiliated with a department that is supported financially by a pharmaceutical company, the authors received no current funding for this study, and their department affiliation does not alter their adherence to all the full journal policies on sharing data and materials.

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Hata, S., Ushigome, E., Hosomi, Y. et al. Impact of continued high blood pressure on the progression of diabetic nephropathy after 10 years: KAMOGAWA-HBP study. Hypertens Res 46, 565–574 (2023). https://doi.org/10.1038/s41440-022-01136-3

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