Elevated pulse pressure and risk of chronic kidney disease by hypertension status: A longitudinal study in Japanese adults

Introduction Little is known about the relationship between pulse pressure (PP) and incident chronic kidney disease (CKD) in Asian populations, particularly when analyzed separately by hypertension status. Aim This study aimed to assess the association between PP and subsequent onset of CKD in Japanese adults. Methods This longitudinal study included middle-aged and older Japanese citizens who participated in administrative checkups (1998–2024) conducted by Zentsuji City. The relationship between PP (diastolic blood pressure subtracted from systolic blood pressure) and incident CKD (estimated glomerular filtration rate <60 mL/min/1.73 m 2 ) was evaluated by hypertension status, using the Weibull accelerated failure time model. PP was treated as a time-varying variable and categorized into <40 (reference), 40–<60, and ≥60 mmHg. In addition to the crude model, two adjusted models were created to control for potential confounders. Results Among 15788 participants, 8881 (men: 42.7%) were examined in the study. The mean follow-up time was 6.21 years for non-hypertensive participants and 6.27 years for hypertensive participants. Higher PP was associated with higher rate of CKD incidence regardless of prevalent hypertension. In non-hypertensive participants, PP ≥60 mmHg had a 10% shorter time to CKD onset (95% confidence interval: 3%–16%) compared with PP <40 mmHg. In hypertensive participants, attenuated results were observed, with all 95% confidence intervals crossing the null value. Conclusions Elevated PP may serve as a useful indicator for CKD development in non-hypertensive Japanese subjects. Regular BP monitoring may assist in developing public health strategies for CKD prevention, especially among non-hypertensive Asian populations.