Key result
An elevated systolic blood pressure trajectory was associated with a 2.1-fold increased risk of developing new-onset chronic kidney disease compared to a normal trajectory (HR 2.114).
Why the study?
Hypertension is the leading cause of CKD, but the effect of long-term blood pressure changes on the development of CKD remains unknown.
Does an elevated long-term systolic blood pressure trajectory increase the risk of incident chronic kidney disease in adults aged ≥40 years?
Cohort (n=111,900)
Does an elevated long-term systolic blood pressure trajectory increase the risk of incident chronic kidney disease in adults aged ≥40 years?
Hazard Ratio: 2.114 (95% CI 1.989–2.246)
p-value: p=<0.001
An elevated longitudinal systolic blood pressure trajectory is independently associated with a higher incidence of new-onset chronic kidney disease in middle-aged men, highlighting the importance of long-term BP control.
BP trajectory monitoring may aid CKD risk stratification; leaves open whether targeting trajectories alters incidence.
OBJECTIVES: Chronic kidney disease (CKD) is a prevalent health issue that causes the irreversible loss of functioning nephrons, end-stage renal disease, cardiovascular disease, and premature mortality. Hypertension is the leading cause of CKD. However, the effect of long-term blood pressure (BP) changes on the development of CKD is still unknown. Therefore, the current study investigated the association between BP trajectory and the future development of CKD. METHODS: In this study, 246,874 individuals aged ≥40 years who underwent health examinations during the screening period (2002-2009) were evaluated. The systolic blood pressure (SBP) trajectory was determined using latent-class mixture modeling. New-onset CKD was identified during the follow-up period (2010-2019). The association between SBP trajectories and new-onset CKD was assessed. RESULTS: In total, 111,900 adults (53,420 females, 51.9±6.4 years old) presented with 2 SBP trajectory classes: class 1 (n=66,935) and class 2 (n=44,965). During the follow-up period, patients with SBP trajectory class 2 had an approximately 2.1-fold increased risk of developing CKD (unadjusted hazard ratio [HR], 2.11; 95% confidence interval [CI], 1.99 to 2.25; p<0.001). In the multivariate analysis adjusted for other significant variables, SBP trajectory class 2 was significantly associated with CKD in males (HR, 1.09; 95% CI, 1.00 to 1.19; p=0.037), but not in females (HR, 1.06; 95% CI, 0.95 to 1.18; p=0.321). CONCLUSIONS: An elevated longitudinal BP was associated with a higher incidence of CKD in male participants aged ≥40 years. Nevertheless, further studies are needed to validate the clinical significance of an elevated SBP trajectory on CKD development.
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Hwang et al. (2024) conducted a cohort in Chronic kidney disease (n=111,900). Elevated systolic blood pressure trajectory (class 2) vs. Normal systolic blood pressure trajectory (class 1) was evaluated on New-onset chronic kidney disease (HR 2.114, 95% CI 1.989-2.246, p=<0.001). An elevated systolic blood pressure trajectory was associated with a 2.1-fold increased risk of developing new-onset chronic kidney disease compared to a normal trajectory (HR 2.114).
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