|Title||Association Between Hypertension and Kidney Function Decline: The Atherosclerosis Risk in Communities (ARIC) Study.|
|Publication Type||Journal Article|
|Year of Publication||2019|
|Authors||Yu Z, Rebholz CM, Wong E, Chen Y, Matsushita K, Coresh JJ|
|Secondary Authors||Grams ME|
|Journal||Am J Kidney Dis|
|Date Published||2019 09|
|Keywords||African Americans, Antihypertensive Agents, Atherosclerosis, European Continental Ancestry Group, Female, Follow-Up Studies, Glomerular Filtration Rate, Humans, Hypertension, Kidney, Male, Middle Aged, Prospective Studies, Time Factors|
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, -0.11mL/min/1.73m; stage 1 hypertension, -0.15mL/min/1.73m; stage 2 hypertension without medication, -0.36mL/min/1.73m; stage 2 hypertension with medication, -0.17mL/min/1.73m; African Americans: elevated blood pressure, -0.21mL/min/1.73m; stage 1 hypertension, -0.16mL/min/1.73m; stage 2 hypertension without medication, -0.50mL/min/1.73m; stage 2 hypertension with medication, -0.16mL/min/1.73m). 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.
|Alternate Journal||Am J Kidney Dis|
|PubMed Central ID||PMC6760841|
|Grant List||HHSN268201700005I / HL / NHLBI NIH HHS / United States |
HHSN268201700004I / HL / NHLBI NIH HHS / United States
R21 HL143089 / HL / NHLBI NIH HHS / United States
HHSN268201700003I / HL / NHLBI NIH HHS / United States
HHSN268201700001I / HL / NHLBI NIH HHS / United States
K01 DK107782 / DK / NIDDK NIH HHS / United States
HHSN268201700002I / HL / NHLBI NIH HHS / United States