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 - Funding Information:
Dr Rebholz is supported by a Mentored Research Scientist Development Award from the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health (NIH; K01 DK107782 ) and a grant from the National Heart, Lung, and Blood Institute (NHLBI; R21 HL143089 ). The ARIC Study has been funded in whole or in part with federal funds from the NHLBI, NIH, Department of Health and Human Services , under contract nos. HHSN268201700001I , HHSN268201700002I , HHSN268201700003I , HHSN268201700004I , and HHSN268201700005I . None of the funders had any role in study design; collection, analysis, and interpretation of data; writing the report; or the decision to submit this report for publication.
Funding Information:
Zhi Yu, BM, MS, Casey M. Rebholz, PhD, MS, MNSP, MPH, Eugenia Wong, MHS, Yuan Chen, MS, Kunihiro Matsushita, MD, PhD, Josef Coresh, MD, PhD, and Morgan E. Grams, MD, PhD. Research idea and study design: ZY, CMR, KM, JC, MEG; data acquisition: JC; data analysis/interpretation: ZY, CMR, EW, YC, KM, JC, MEG; statistical analysis: ZY, EW, YC; supervision or mentorship: KM, JC, MEG. Each author contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved. Dr Rebholz is supported by a Mentored Research Scientist Development Award from the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health (NIH; K01 DK107782) and a grant from the National Heart, Lung, and Blood Institute (NHLBI; R21 HL143089). The ARIC Study has been funded in whole or in part with federal funds from the NHLBI, NIH, Department of Health and Human Services, under contract nos. HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700004I, and HHSN268201700005I. None of the funders had any role in study design; collection, analysis, and interpretation of data; writing the report; or the decision to submit this report for publication. The authors declare that they have no other relevant financial interests. The authors thank the staff and participants of the ARIC Study for important contributions. Some of the data reported here have been supplied by the USRDS. The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as official policy or interpretation of the US government. Received August 27, 2018. Evaluated by 2 external peer reviewers and a statistician, with direct editorial input from an Associate Editor, who served as Acting Editor-in-Chief. Accepted in revised form February 12, 2019. The involvement of an Acting Editor-in-Chief was to comply with AJKD's procedures for potential conflicts of interest for editors, described in the Information for Authors & Journal Policies.
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
VL - 74
SP - 310
EP - 319
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
SN - 0272-6386
IS - 3
ER -