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  • Special Issue: Current evidence and perspectives for hypertension management in Asia
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The association of BP with cardiovascular outcomes in patients with dipstick proteinuria and preserved kidney function

Hypertension Research volume 46, pages 856–867 (2023)Cite this article

Abstract

Little is known about the relationship between blood pressure (BP) and incident cardiovascular disease (CVD) in people with proteinuria and a preserved estimated glomerular filtration rate (eGFR). This study sought to investigate the association of BP with CVD risk in adults with proteinuria and preserved eGFR. We studied 188,837 individuals with proteinuria and preserved eGFR ≥60 mL/min/1.73 m2. We categorized individuals who were not taking BP-lowering medications into four groups based on the 2017 American College of Cardiology/American Heart Association BP guideline and categorized those who were taking BP-lowering medications using the same BP ranges. The primary outcome was a composite CVD endpoint that included myocardial infarction, angina pectoris, stroke, and heart failure. Over a mean follow-up of 1,050 days, 7,039 CVD events were identified. Compared with normal BP, stage 1 hypertension (hazard ratio [HR]: 1.30, 95% confidence interval [95% CI]: 1.21–1.40) and stage 2 hypertension (HR: 2.17, 95% CI: 2.01–2.34) were associated with an increased risk for CVD events among medication-naïve individuals. Only stage 2 hypertension range (HR: 1.19, 95% CI: 1.02–1.38) was associated with an increased CVD event risk among people taking BP-lowering medications. Restricted cubic spline analysis showed that the risk of CVD events increased monotonically with BP at an SBP/DBP > 120/80 mmHg among medication-naïve individuals, but risk increased only at an SBP/DBP > 140/90 mmHg among individuals taking BP-lowering medications. In conclusion, among people with proteinuria and preserved eGFR, stage 1 and stage 2 hypertension were associated with a greater risk of CVD among medication-naïve individuals, whereas only stage 2 hypertension was associated with an increased CVD risk among those taking BP-lowering medications.

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Funding

This work was supported by grants from the Ministry of Health, Labour and Welfare, Japan (19AA2007 and H30-Policy- Designated-004) and the Ministry of Education, Culture, Sports, Sci-ence and Technology, Japan (17H04141). The funding sources had no role in the design or implementation of this study.

Author information

Authors and Affiliations

  1. Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan

    Yuta Suzuki, Hidehiro Kaneko, Katsuhito Fujiu, Satoshi Matsuoka, Norifumi Takeda, Hiroyuki Morita & Issei Komuro

  2. Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Saitama, Japan

    Yuta Suzuki

  3. Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan

    Hidehiro Kaneko & Katsuhito Fujiu

  4. Department of Advanced Epidemiology, NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan

    Yuichiro Yano

  5. Department of Family Medicine and Community Health, Duke University, Durham, NC, USA

    Yuichiro Yano

  6. Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Akira Okada

  7. Department of Health Services Research, The University of Tokyo, Tokyo, Japan

    Nobuaki Michihata & Taisuke Jo

  8. Department of Cardiovascular Medicine, Saga University, Saga, Japan

    Koichi Node

  9. Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan

    Hideo Yasunaga

  10. Division of Cardiovascular Disease, Department of Medicine, University of Alabama, Birmingham, AL, USA

    Suzanne Oparil

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  1. Yuta Suzuki
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Correspondence to Hidehiro Kaneko.

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Conflict of interest

Research funding and scholarship funds (HK and KF) were received from Medtronic Japan Co., Ltd., Boston Scientific Japan Co., Ltd., Biotronik Japan, Simplex QUANTUM Co., Ltd., and Fukuda Denshi, Central Tokyo Co., Ltd. The remaining authors declare no competing interests.

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IRB information: The Clinical Research Review Board of the University of Tokyo [2018–10862] approved this study.

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Suzuki, Y., Kaneko, H., Yano, Y. et al. The association of BP with cardiovascular outcomes in patients with dipstick proteinuria and preserved kidney function. Hypertens Res 46, 856–867 (2023). https://doi.org/10.1038/s41440-022-01146-1

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  • DOI: https://doi.org/10.1038/s41440-022-01146-1

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