Key result
Low DBP is linked to ~26% greater eGFR decline risk in high pulse pressure patients.
Why the study?
Unlike systolic blood pressure, the prognostic value of diastolic blood pressure in kidney function has not been established, and pulse pressure was hypothesized to affect this relationship.
Does diastolic blood pressure level affect the risk of a 30% decline in eGFR in the general population?
Cohort (n=725,022)
Yes
Does diastolic blood pressure level affect the risk of a 30% decline in eGFR in the general population?
Effect estimate: HR 1.26 (95% CI 1.15-1.38)
Pulse pressure modifies the prognostic value of diastolic blood pressure for kidney function decline, with low DBP increasing risk only in patients with high pulse pressure.
Low DBP associated with eGFR decline only in high PP; hypothesis-generating and should not change practice.
Background Unlike systolic blood pressure (SBP), the prognostic value of diastolic blood pressure (DBP) in kidney function has not been established. We hypothesized that pulse pressure (PP), which is associated with arteriosclerosis, would affect the prognostic value of DBP. Methods This longitudinal study used data from the Japan Specific Health Checkups Study conducted between 2008 and 2014. The participants were stratified into 3 PP subgroups (low-PP ≤39, normal-PP 40–59, and high-PP ≥60 mmHg). The exposures of interest were SBP and DBP, and the association between SBP/DBP and kidney outcomes (30% decline in the estimated glomerular filtration rate from baseline) was examined in each PP subgroup using a Cox proportional hazards model. Results Among 725,022 participants, 20,414 (2.8%) developed kidney outcomes during a median follow-up period of 34.6 months. Higher SBP was consistently associated with a higher incidence of kidney outcome in all PP subgroups. Although DBP had a positive linear association with the incidence of kidney outcome in low-and normal-PP subgroups, both lower (≤60 mmHg) and higher (≥101 mmHg) DBP were associated with a higher incidence of kidney outcome in high-PP subgroup with U-shaped curve. Hazard ratios (95% confidence intervals) of ≤60 mmHg (reference: 61-80 mmHg in normal-PP subgroup) and ≥101 mmHg were 1.26 (1.15–1.38) and 1.86 (1.62–2.14), respectively. Conclusion In this large population-based cohort, DBP was differently associated with kidney outcome by PP levels; lower DBP was significantly associated with a higher incidence of kidney outcome in high-PP subgroup but not in low-and normal-PP subgroups.
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Tamaki et al. (2023) conducted a cohort in Decrease in kidney function (n=725,022). Diastolic blood pressure ≤60 mmHg in high pulse pressure (≥60 mmHg) subgroup vs. Diastolic blood pressure 61-80 mmHg in normal pulse pressure (40-59 mmHg) subgroup was evaluated on 30% decline in estimated glomerular filtration rate (eGFR) from baseline (HR 1.26, 95% CI 1.15-1.38). Lower diastolic blood pressure (≤60 mmHg) was significantly associated with a higher incidence of a 30% decline in eGFR in the high pulse pressure subgroup (HR 1.26), but not in low- and normal-PP subgroups.
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