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December 20, 2021Journal of Translational MedicineOpen Access

High pulse pressure (≥ 60 mmHg) significantly increased the risk of rapid decline in kidney function (OR 1.34) among middle-aged and older adults without pre-existing hypertension.

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Why the study?

The association between blood pressure and kidney function among middle-aged and older general populations without hypertension remains unclear.

Do high pulse pressure and abnormal systolic blood pressure increase the risk of rapid eGFR decline in a middle-aged and older general population without hypertension?

Population

4,534 participants aged ≥ 45 years without pre-existing hypertension in China

Comparison

Categories and combinations of systolic blood pressure, diastolic blood pressure, and pulse pressure

Design

Longitudinal cohort study

Key result

High pulse pressure (≥ 60 mmHg) significantly increased the risk of rapid decline in kidney function (OR 1.34) among middle-aged and older adults without pre-existing hypertension.

Authors

HWHuaiyu WangQMQinqin MengCYChao Yang

Discussion

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Overview

May support pulse pressure assessment for kidney risk in normotensives; hypothesis-generating and should not yet change practice.

Study Design

Type

Cohort (n=4,534)

Multicenter

Yes

Structured PICO

Do high pulse pressure and abnormal systolic blood pressure increase the risk of rapid eGFR decline in a middle-aged and older general population without hypertension?

P
Population
4,534 adults aged 45 years or older without pre-existing hypertension, followed for 4 years to assess the risk of rapid decline in kidney function.
E
Exposure
High pulse pressure (≥ 60 mmHg), low systolic blood pressure (< 120 mmHg), high systolic blood pressure (130-139 mmHg), and their combinations.
C
Comparator
Normal pulse pressure (< 60 mmHg) and medium systolic blood pressure (120-129 mmHg).
O
Outcome
Rapid decline of estimated glomerular filtration rate (eGFR decline ≥ 4 ml/min/1.73 m²/year) between 2011 and 2015.surrogate

Main Result

Odds Ratio: 1.34 (95% CI 1.02–1.75)

Absolute Event Rate: 19.3% vs 14.9%

p-value: p=0.036

Both high pulse pressure and abnormal systolic blood pressure (either <120 or 130-139 mmHg) are associated with an increased risk of rapid kidney function decline in middle-aged and older adults without hypertension.

Limitations

  • Information of albuminuria was not available
  • Small case number of participants with low SBP and high PP limited age-stratified analyses
  • Observational nature of the study limited the ability to make causal inference
  • Absence of gene data to investigate genetic factors associated with BP components
  • Possibility of residual confounding exists

Cite This Study

Wang et al. (2021) conducted a cohort in Rapid decline of kidney function (n=4,534). High pulse pressure (≥ 60 mmHg) vs. Normal pulse pressure (< 60 mmHg) was evaluated on Rapid decline of estimated glomerular filtration rate (eGFR decline ≥ 4 ml/min/1.73 m2/year) (OR 1.34, 95% CI 1.02-1.75, p=0.036). High pulse pressure (≥ 60 mmHg) significantly increased the risk of rapid decline in kidney function (OR 1.34) among middle-aged and older adults without pre-existing hypertension.

synapsesocial.com/papers/6a20e4911e73f094422aa002https://doi.org/10.1186/s12967-021-03176-8
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Blood Pressure Components and Decline in Kidney Function in Community-Living Older Adults: The Cardiovascular Health Study2013 · 51 citations
  2. 2Blood Pressure is Associated with Rapid Kidney Function Decline in a Very Elderly Hypertensive Chinese Population2020 · 8 citations
  3. 3Blood pressure and renal function decline2014 · 23 citations
  4. 4Longitudinal Blood Pressure Changes and Kidney Function Decline in Persons Without Chronic Kidney Disease: Findings From the MESA Study2017 · 17 citations
  5. 5The correlation between blood pressure and kidney function decline in older people: a registry-based cohort study2015 · 38 citations