Kidney Week

Abstract: FR-PO1017

Systolic Blood Pressure and Risk of Incident CKD: A Nationwide Cohort Study of 10 Million Adults in South Korea

Session Information

• Hypertension and CVD: Clinical Outcomes, Trials
  November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Hypertension and CVD

• 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

• Kim, Hyung Woo, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Korea (the Republic of)

Hyung Woo Kim,

• Jung, Chan-Young, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Korea (the Republic of)

Chan-Young Jung,

• Ko, Byounghwi, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Korea (the Republic of)

Byounghwi Ko,

• Jo, Wonji, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Korea (the Republic of)

Wonji Jo,

• Kang, Shin-Wook, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Korea (the Republic of)

Shin-Wook Kang,

• Chang, Tae ik, National Health Insurance Service Medical Center, Ilsan Hospital, Gyunggi-do, Korea (the Republic of)

Tae ik Chang,

Background

In the general population, guidelines recommend a target blood pressure (BP) <120/80 mmHg in order to reduce cardiovascular risk. However, the optimal BP to prevent chronic kidney disease (CKD) is unknown.

Methods

In a national population-based cohort of 10.5 million adults who underwent National Health Insurance Service health examination between 2009 and 2015 and had an estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73m² at baseline, we studied the association of time-updated and baseline systolic BP (SBP) with risk of incident CKD using marginal structural models (MSMs) and Cox models. Incident CKD was defined as de novo development of eGFR <60 mL/min per 1.73m² for at least two consecutive measurements.

Results

During 49,169,311 person-years of follow-up, incident CKD developed in 172,423 (1.64%) subjects with a crude event rate of 3.51 (95% CI, 3.49-3.52) per 1,000 person-years. Using MSMs, we found a graded association between incrementally higher time-updated SBP levels ≥130 mmHg and risk of incident CKD, whereas SBP levels <120 mmHg were associated with lower risk (reference: 120-129 mmHg): HRs (95% CIs) were 0.57 (0.55-0.58), 0.81 (0.80-0.82), 1.41 (1.39-1.43), and 2.16 (2.12-2.19) for SBP <110, 110-119, 130-139, and ≥140 mmHg, respectively. Using Cox models, the corresponding HRs for the noted SBP range were 0.84 (0.82-0.85), 0.92 (0.91-0.94), 1.11 (1.09-1.12), and 1.30 (1.28-1.32), respectively. Among subjects receiving antihypertensive medications, time-updated SBP of <110 mmHg was associated with higher risk of CKD: HR (95% CI) 1.07 (1.00-1.15).

Conclusion

In healthy people without kidney disease, higher SBP ≥130 mmHg was associated with higher risk of incident CKD. However, among those receiving antihypertensive therapy, low SBP <110 mmHg was also associated with incident CKD risk, suggesting that excessive BP control may contribute to adverse renal outcomes.