Key result
Among adults with albuminuria, the prevalence of moderate-severe renal insufficiency progressively increased from normal blood pressure to prehypertension and undiagnosed hypertension (1.43%, 3.44%, and 10.96%, respectively; P for trend <0.0001).
Why the study?
Is the association between high blood pressure and reduced renal function modified by albuminuria status in adults without known cardiovascular or kidney disease?
Cross-Sectional (n=12,440)
Is the association between high blood pressure and reduced renal function modified by albuminuria status in adults without known cardiovascular or kidney disease?
Absolute Event Rate: 10.96% vs 1.43%
p-value: p=<0.0001
The association between high blood pressure and reduced renal function is dependent on the presence of albuminuria, suggesting that intensive blood pressure control may be most beneficial in patients with albuminuria.
Higher BP categories associate with rising renal insufficiency prevalence in albuminuric adults; hypothesis-generating for targeted BP trials, should not yet change practice.
BACKGROUND: The relationship between hypertension and kidney disease is complicated. Clinical trials found intense blood pressure control was not associated with alterations in glomerular filtration rate (GFR) in all patients but did slow the rate of GFR decline among those with a higher baseline proteinuria. However, the underlying mechanism has been unclear. METHODS: We tested the hypothesis that the association between high blood pressure and renal function is modified by albuminuria status by conducting analyses in a cross-sectional study with 12,440 adult participants without known kidney diseases, diabetes or cardiovascular diseases, participating in the National Health and Nutrition Examination Survey (NHANES) 1999-2006. RESULTS: 1226 out of 12440 were found to have unknown high blood pressure and 4494 were found to have reduced renal function. Overall, a moderate association was found between high blood pressure and renal function insufficiency in all participants analyzed. However, among participants with albuminuria, the prevalence of moderate-severe renal insufficiency substantially and progressively increased from normal subjects to prehypertensive and undiagnosed hypertensive subjects (1.43%, 3.44%, 10.96%, respectively, P for trend<0.0001); on the other hand, the prevalence of undiagnosed hypertension was also significantly higher among subjects with moderate-severe renal insufficiency than those with mild renal insufficiency (35.54% Vs 19.09%, P value <0.05), supporting an association between hypertension and renal function damage. In contrast, no association between hypertension and renal insufficiency was observed among those without albuminuria in this population. Similar findings were observed when the CKD-EPI equation was used. CONCLUSIONS: The association between high blood pressure and reduced renal function could be dependent upon the albuminuria status. This finding may provide a possible explanation for results observed in clinical trials of intensive blood pressure control. Further studies are warranted to confirm our findings.
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Yan et al. (2012) conducted a cross-sectional in Renal insufficiency (n=12,440). High blood pressure vs. Normal blood pressure was evaluated on Prevalence of moderate-severe renal insufficiency among participants with albuminuria (p=<0.0001). Among adults with albuminuria, the prevalence of moderate-severe renal insufficiency progressively increased from normal blood pressure to prehypertension and undiagnosed hypertension (1.43%, 3.44%, and 10.96%, respectively; P for trend <0.0001).
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