Associations of Long‐Term Blood Pressure Burden and Variability With Kidney Function Decline

ABSTRACT Long‐term blood pressure (BP) burden and visit‐to‐visit BP variability may better capture cumulative hemodynamic stress on the kidneys than single‐visit BP measurements, yet evidence linking these metrics with kidney function decline in the general population remains limited. We analyzed 2,821 adults with preserved kidney function from a prospective cohort study. Cumulative BP exposure and visit‐to‐visit BP variability were derived from BP measurements obtained at baseline and two follow‐up visits. Outcomes included annual estimated glomerular filtration rate (eGFR) slope and study‐defined incident chronic kidney disease (CKD). Higher long‐term BP exposure, particularly systolic BP (SBP), and greater BP variability were associated with faster kidney function decline. A 1‐standard deviation increase in cumulative SBP was associated with a more negative annual eGFR slope (β≈−0.15 to −0.18 mL/min/1.73 m 2 per year). Cumulative SBP was also independently associated with study‐defined incident CKD (hazard ratio 1.45; 95% confidence interval 1.15–1.83), whereas associations for diastolic BP and BP variability were generally weaker. No evidence of nonlinearity or significant effect modification was observed. These findings suggest that long‐term BP burden, particularly cumulative SBP, is associated with accelerated kidney function decline in the general population.