ARIC: hypertension tied to higher risk for later CKD

  • Yu Z & al.
  • Am J Kidney Dis
  • 25 Apr 2019

  • International Clinical Digest
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Takeaway

  • High baseline BP in middle age is associated with faster renal function decline and greater 30-year risk for chronic kidney disease (CKD).

Why this matters

  • African-Americans had similar probability of early-stage CKD but higher probability of late-stage disease than whites.

Study design

  • Atherosclerosis Risk in Communities (ARIC) 30-year study of 14,854 middle-aged individuals aged 45-64 years (74.1% white, 25.9% African-American).
  • Funding: NIH.        

Key results

  • Baseline: proportion with stage I hypertension (HTN) (whites, 13.2%, African-Americans, 15.8%), stage II HTN without medication (7.3%, 14.9%), stage II HTN with medication (19.4%, 39.9%).
  • Annual estimated glomerular filtration rate (eGFR, in mL/minute/1.73 m2) decline:
    • Elevated BP: whites, −0.11; African-Americans, −0.21,
    • Stage I HTN: whites, −0.15; African-Americans, −0.16,
    • Stage II HTN without medication: whites, −0.36; African-Americans, −0.50, and
    • Stage II HTN with medication: whites, −0.17; African-Americans, −0.16.
  • 30-year predicted probability of stage IIIa+ CKD was similar for whites and African-Americans with normal BP (54.4%, 55.4%), elevated BP (61.6%, 62.8%), stage I HTN (64.7%, 60.9%), stage II HTN (no medication: 78.1%, 76.1%; medication: 70.9%, 66.6%).
  • 30-year probability of CKD stage IV+ was higher among African-Americans with normal BP (22.3% vs whites, 7.0%), elevated BP (26.0% vs 9.0%), stage I HTN (25.4% vs 10.1%), nonmedicated stage II HTN (32.5% vs 15.8%), and medicated stage II HTN (27.5% vs 12.4%).

Limitations

  • 5 eGFR assessments.