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Cross-classification by systolic and diastolic blood pressure levels and chronic kidney disease, proteinuria, or kidney function decline

Hypertension Research volume 46, pages 1860–1869 (2023)Cite this article

Abstract

Predicting and preventing new-onset chronic kidney disease (CKD) through blood pressure (BP) measurements is worthwhile. This study assessed the risk of CKD, which was defined as proteinuria and/or an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, according to cross-classification by systolic and diastolic BP (SBP and DBP). This retrospective population-based cohort study analyzed data from 1,492,291 participants without CKD and without antihypertensive treatment in the JMDC database, which contains the annual health check-up data of Japanese aged <75 years. During a mean follow-up of 3.2 years, CKD incidence, proteinuria, and eGFR <60 mL/min/1.73 m2 occurred in 92,587, 67,021, and 28,858 participants, respectively. When the SBP/DBP <120/<80 mmHg group was set as a reference, both high SBP and DBP were significantly associated with an elevated CKD risk. DBP tended to be more strongly associated with CKD risk than SBP; the hazard ratio of CKD was 1.44–1.80 in the group with SBP/DBP of 130–139/≥90 mmHg and 1.23–1.47 in the group with SBP/DBP of ≥140/80–89 mmHg. A similar result was observed for developing proteinuria and eGFR <60 mL/min/1.73 m2. SBP/DBP ≥150/<80 mmHg was strongly associated with an elevated CKD risk due to the increased risk of eGFR decline. High BP, especially isolated high DBP levels, is a significant risk factor for CKD among individuals around middle age without kidney disease. Moreover, attention should be paid to kidney function, particularly eGFR decline, in the case of low DBP with extremely high SBP levels.

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All data and study materials will not be made available to other researchers in compliance with our contract with JMDC Inc.

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Acknowledgements

The authors are grateful to all the staff at JMDC Inc. who advised us on the structure of the JMDC data used in the present study.

Funding

This study was supported by Grants for Scientific Research (17K15853 and 21K10478) from the Ministry of Education, Culture, Sports, Science, and Technology, Japan; research support from Bayer Yakuhin Co., Ltd.; the Health Care Science Institute Research Grant; a grant from the Foundation for Total Health Promotion; and the Medical Research Encouragement Prize from the Japan Medical Association.

Author information

Authors and Affiliations

  1. Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan

    Tsukasa Suenaga, Michihiro Satoh, Takahisa Murakami, Shingo Nakayama, Hideaki Hashimoto, Maya Toyama, Tomoko Muroya & Hirohito Metoki

  2. Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan

    Michihiro Satoh, Takahisa Murakami, Taku Obara, Hideaki Hashimoto, Maya Toyama, Tomoko Muroya & Hirohito Metoki

  3. Division of Aging and Geriatric Dentistry, Department of Rehabilitation Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan

    Takahisa Murakami

  4. Department of Endocrinology and Applied Medical Science, Tohoku University Graduate School of Medicine, Sendai, Japan

    Takuo Hirose

  5. Division of Nephrology and Endocrinology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan

    Takuo Hirose, Shingo Nakayama, Hideaki Hashimoto & Takefumi Mori

  6. Division of Integrative Renal Replacement Therapy, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan

    Takuo Hirose

  7. Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, Japan

    Taku Obara

  8. Department of Nephrology, Japan Self-Defense Forces Sendai Hospital, Sendai, Japan

    Maya Toyama

  9. Division of Internal Medicine, Izumi Hospital, Sendai, Japan

    Tomoko Muroya

  10. Division of Geriatric and Community Medicine, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan

    Atsuhiro Kanno

  11. Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan

    Takayoshi Ohkubo

  12. Tohoku Institute for Management of Blood Pressure, Sendai, Japan

    Takayoshi Ohkubo, Yutaka Imai & Hirohito Metoki

Authors
  1. Tsukasa Suenaga
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Contributions

Research idea and study design TS, MS, TMurakami, TH, SN, TMori, TOhkubo, YI, and HM. Data acquisition MS, TObara, TOhkubo, YI, and HM. Data analysis/interpretation TS, MS, TMurakami, TH, TObara, SN, HH, MT, TMuroya, AK, TMori, TOhkubo, YI, and HM. Statistical analysis TS and MS. Supervision or mentorship MS, TMurakami, SN, and HM. Each author contributed important intellectual content during paper drafting or revision and agrees to be personally accountable for the individual’s contributions and to ensure that questions pertaining to the accuracy or integrity of any portion of the work, even one in which the author was not directly involved, are appropriately investigated and resolved, including with documentation in the literature, if appropriate.

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Correspondence to Michihiro Satoh.

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Conflict of interest

The Division of Public Health, Hygiene, and Epidemiology, Faculty of Medicine, and Tohoku Medical and Pharmaceutical University have received scholarship donations or research support from Pfizer Japan Inc.; Daiichi Sankyo Co., Ltd.; Astellas Pharma Inc.; Takeda Pharmaceutical Co., Ltd.; and Bayer Yakuhin Co., Ltd. in the past three years. T. Ohkubo, Y. Imai, and H. Metoki concurrently held the position of director at the Tohoku Institute for Management of Blood Pressure, which was supported by Omron Healthcare Co., Ltd.

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Suenaga, T., Satoh, M., Murakami, T. et al. Cross-classification by systolic and diastolic blood pressure levels and chronic kidney disease, proteinuria, or kidney function decline. Hypertens Res 46, 1860–1869 (2023). https://doi.org/10.1038/s41440-023-01267-1

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