TY - JOUR
T1 - Association Between Hypertension and Kidney Function Decline
T2 - The Atherosclerosis Risk in Communities (ARIC) Study
AU - Yu, Zhi
AU - Rebholz, Casey M.
AU - Wong, Eugenia
AU - Chen, Yuan
AU - Matsushita, Kunihiro
AU - Coresh, Josef
AU - Grams, Morgan E.
N1 - Publisher Copyright:
© 2019
PY - 2019/9
Y1 - 2019/9
N2 - Rationale & Objective: The relationship between hypertension, antihypertension medication use, and change in glomerular filtration rate (GFR) over time among individuals with preserved GFR requires investigation. Study Design: Observational study. Setting & Participants: 14,854 participants from the Atherosclerosis Risk in Communities (ARIC) Study. Predictors: Baseline hypertension status (1987-1989) was categorized according to the 2017 American College of Cardiology/American Heart Association Clinical Practice Guideline as normal blood pressure, elevated blood pressure, stage 1 hypertension, stage 2 hypertension without medication, or stage 2 hypertension with medication. Outcomes: Slope of estimated GFR (eGFR) at 5 study visits over 30 years. Analytical Approach: Mixed models with random intercepts and random slopes were fit to evaluate the association between baseline hypertension status and slope of eGFR. Results: At baseline, 13.2%, 7.3%, and 19.4% of whites and 15.8%, 14.9%, and 39.9% of African Americans had stage 1 hypertension, stage 2 hypertension without medication, and stage 2 hypertension with medication. Compared with those with normal blood pressure, the annual eGFR decline was greater in people with higher blood pressure (whites: elevated blood pressure, −0.11 mL/min/1.73 m2; stage 1 hypertension, −0.15 mL/min/1.73 m2; stage 2 hypertension without medication, −0.36 mL/min/1.73 m2; stage 2 hypertension with medication, −0.17 mL/min/1.73 m2; African Americans: elevated blood pressure, −0.21 mL/min/1.73 m2; stage 1 hypertension, −0.16 mL/min/1.73 m2; stage 2 hypertension without medication, −0.50 mL/min/1.73 m2; stage 2 hypertension with medication, −0.16 mL/min/1.73 m2). The 30-year predicted probabilities of developing chronic kidney disease stage G3a+ with normal blood pressure, elevated blood pressure, stage 1 hypertension, stage 2 hypertension without medication, or stage 2 hypertension with medication among whites were 54.4%, 61.6%, 64.7%, 78.1%, and 70.9%, respectively, and 55.4%, 62.8%, 60.9%, 76.1%, and 66.6% among African Americans. Limitations: Slope estimated using a maximum of 5 eGFR assessments; differential loss to follow-up. Conclusions: Compared to normotension, baseline hypertension status was associated with faster kidney function decline over 30-year follow-up in a general population cohort. This difference was attenuated among people using antihypertensive medications.
AB - Rationale & Objective: The relationship between hypertension, antihypertension medication use, and change in glomerular filtration rate (GFR) over time among individuals with preserved GFR requires investigation. Study Design: Observational study. Setting & Participants: 14,854 participants from the Atherosclerosis Risk in Communities (ARIC) Study. Predictors: Baseline hypertension status (1987-1989) was categorized according to the 2017 American College of Cardiology/American Heart Association Clinical Practice Guideline as normal blood pressure, elevated blood pressure, stage 1 hypertension, stage 2 hypertension without medication, or stage 2 hypertension with medication. Outcomes: Slope of estimated GFR (eGFR) at 5 study visits over 30 years. Analytical Approach: Mixed models with random intercepts and random slopes were fit to evaluate the association between baseline hypertension status and slope of eGFR. Results: At baseline, 13.2%, 7.3%, and 19.4% of whites and 15.8%, 14.9%, and 39.9% of African Americans had stage 1 hypertension, stage 2 hypertension without medication, and stage 2 hypertension with medication. Compared with those with normal blood pressure, the annual eGFR decline was greater in people with higher blood pressure (whites: elevated blood pressure, −0.11 mL/min/1.73 m2; stage 1 hypertension, −0.15 mL/min/1.73 m2; stage 2 hypertension without medication, −0.36 mL/min/1.73 m2; stage 2 hypertension with medication, −0.17 mL/min/1.73 m2; African Americans: elevated blood pressure, −0.21 mL/min/1.73 m2; stage 1 hypertension, −0.16 mL/min/1.73 m2; stage 2 hypertension without medication, −0.50 mL/min/1.73 m2; stage 2 hypertension with medication, −0.16 mL/min/1.73 m2). The 30-year predicted probabilities of developing chronic kidney disease stage G3a+ with normal blood pressure, elevated blood pressure, stage 1 hypertension, stage 2 hypertension without medication, or stage 2 hypertension with medication among whites were 54.4%, 61.6%, 64.7%, 78.1%, and 70.9%, respectively, and 55.4%, 62.8%, 60.9%, 76.1%, and 66.6% among African Americans. Limitations: Slope estimated using a maximum of 5 eGFR assessments; differential loss to follow-up. Conclusions: Compared to normotension, baseline hypertension status was associated with faster kidney function decline over 30-year follow-up in a general population cohort. This difference was attenuated among people using antihypertensive medications.
KW - African Americans
KW - CKD risk
KW - Hypertension
KW - blood pressure
KW - chronic kidney disease (CKD)
KW - disease projection
KW - estimated glomerular filtration rate (eGFR)
KW - kidney function
KW - race
KW - racial differences
KW - trajectory
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U2 - 10.1053/j.ajkd.2019.02.015
DO - 10.1053/j.ajkd.2019.02.015
M3 - Article
C2 - 31031087
AN - SCOPUS:85064945558
SN - 0272-6386
VL - 74
SP - 310
EP - 319
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 3
ER -