Adi Leiba1,2,3, Boris Fishman2,4,5, Gilad Twig2, David Gilad2,6, Estela Derazne5, Ari Shamiss7, Tamar Shohat5,8, Ofir Ron2, Ehud Grossman4,5. 1. Division of Nephrology and Hypertension, Assuta Ashdod Academic Medical Center, Ben Gurion University, Beer Sheva, Israel. 2. IDF Medical Corps, Tel Hashomer, Ramat Gan, Israel. 3. Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Boston, Massachusetts. 4. Internal Medicine D and Hypertension Unit, The Chaim Sheba Medical Center, Tel Hashomer, Israel. 5. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 6. Department of Physiology and Cell Biology, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel. 7. Assuta Medical Center, Tel Aviv, Israel. 8. Israel Center for Disease Control, Israel Ministry of Health, Tel Hashomer, Israel.
Abstract
Importance: Hypertension is a leading risk factor of cardiovascular morbidity and mortality. The role of nonmalignant hypertension as the sole initiating factor of end-stage renal disease (ESRD) in non-African American populations has recently been questioned. Objective: To investigate the association between hypertension and future ESRD in otherwise healthy adolescents. Design, Setting, and Participants: This retrospective cohort study examined the data of 16- to 19-year-old healthy candidates for military service in the Israel Defense Forces between January 1, 1967, and December 31, 2013. Data were obtained from the central conscription registry of the Israel Defense Forces and the ESRD registry of the Israel Ministry of Health. Participants underwent a comprehensive medical assessment prior to their military service. Individuals with evidence of renal damage or kidney-related risk factors were excluded. The data analysis was conducted from February 12, 2017, to October 16, 2018. Main Outcomes and Measures: End-stage renal disease as recorded by the Israeli ESRD registry, including hemodialysis, peritoneal dialysis, renal transplant diagnosed between January 1, 1990, and December 31, 2014. Results: The cohort included 2 658 238 adolescents (1 596 709 [60.1%] male with a mean [SD] age of 17.4 [0.5] years), of whom 7997 (0.3%) had an established hypertension diagnosis. Half of the individuals in the hypertensive group were overweight (1559 [20.1%]) or obese (2243 [28.9%]), and most (7235 [90.5%]) were male. During a median follow-up of 19.6 years (52 287 945 person-years), 2189 individuals developed ESRD, with an incidence rate of 3.9 per 100 000 person-years. Adolescent hypertension was found to be associated with future ESRD (crude hazard ratio [HR], 5.07; 95% CI, 3.73-6.88). In a multivariable model adjusted for sex, age, years of education, body mass index, and other sociodemographic variables, the HR was 1.98 (95% CI, 1.42-2.77). When excluding participants with severe hypertension, the association with ESRD remained statistically significant (HR, 1.93; 95% CI, 1.37-2.70). In the subanalysis of nonoverweight adolescents, the association between hypertension and ESRD was statistically significant as well (HR, 2.11; 95% CI, 1.05-4.24). Conclusions and Relevance: Hypertension appears to be associated with a doubling of the risk of future ESRD in an otherwise healthy adolescent population.
Importance: Hypertension is a leading risk factor of cardiovascular morbidity and mortality. The role of nonmalignant hypertension as the sole initiating factor of end-stage renal disease (ESRD) in non-African American populations has recently been questioned. Objective: To investigate the association between hypertension and future ESRD in otherwise healthy adolescents. Design, Setting, and Participants: This retrospective cohort study examined the data of 16- to 19-year-old healthy candidates for military service in the Israel Defense Forces between January 1, 1967, and December 31, 2013. Data were obtained from the central conscription registry of the Israel Defense Forces and the ESRD registry of the Israel Ministry of Health. Participants underwent a comprehensive medical assessment prior to their military service. Individuals with evidence of renal damage or kidney-related risk factors were excluded. The data analysis was conducted from February 12, 2017, to October 16, 2018. Main Outcomes and Measures: End-stage renal disease as recorded by the Israeli ESRD registry, including hemodialysis, peritoneal dialysis, renal transplant diagnosed between January 1, 1990, and December 31, 2014. Results: The cohort included 2 658 238 adolescents (1 596 709 [60.1%] male with a mean [SD] age of 17.4 [0.5] years), of whom 7997 (0.3%) had an established hypertension diagnosis. Half of the individuals in the hypertensive group were overweight (1559 [20.1%]) or obese (2243 [28.9%]), and most (7235 [90.5%]) were male. During a median follow-up of 19.6 years (52 287 945 person-years), 2189 individuals developed ESRD, with an incidence rate of 3.9 per 100 000 person-years. Adolescent hypertension was found to be associated with future ESRD (crude hazard ratio [HR], 5.07; 95% CI, 3.73-6.88). In a multivariable model adjusted for sex, age, years of education, body mass index, and other sociodemographic variables, the HR was 1.98 (95% CI, 1.42-2.77). When excluding participants with severe hypertension, the association with ESRD remained statistically significant (HR, 1.93; 95% CI, 1.37-2.70). In the subanalysis of nonoverweight adolescents, the association between hypertension and ESRD was statistically significant as well (HR, 2.11; 95% CI, 1.05-4.24). Conclusions and Relevance: Hypertension appears to be associated with a doubling of the risk of future ESRD in an otherwise healthy adolescent population.
Authors: Katarína Šebeková; Radana Gurecká; Melinda Csongová; Ivana Koborová; Jozef Šebek Journal: Int J Environ Res Public Health Date: 2020-05-21 Impact factor: 3.390
Authors: Sander Groen In 't Woud; Rik Westland; Wout F J Feitz; Nel Roeleveld; Joanna A E van Wijk; Loes F M van der Zanden; Michiel F Schreuder Journal: Eur Urol Open Sci Date: 2021-02-03