Tomoko Usui1,2, Chiho Iseki3, Kunitoshi Iseki4, Koji Kawakami5, Masaomi Nangaku6. 1. Division of Nephrology and Endocrinology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. tusui-tky@umin.ac.jp. 2. Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan. tusui-tky@umin.ac.jp. 3. Okinawa Heart and Renal Association, Clinical Research Support Center, Nakamura Clinic, Okinawa, Japan. 4. Clinical Research Support Center, Nakamura Clinic, Okinawa, Japan. 5. Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan. 6. Division of Nephrology and Endocrinology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Abstract
BACKGROUND: The appropriate blood pressure target to prevent end-stage renal disease (ESRD) is controversial. METHODS: We examined the association between systolic blood pressure (SBP) changes and ESRD incidence in 69,575 participants from the Okinawa general population aged ≥ 20 years who underwent health check-ups in 1993 and more than once in 1994-1996. ESRD incidence was identified using dialysis registry until 2011. Cox proportional hazards model was used to estimate hazard ratio (95% confidence interval) with confounding factor adjustment. RESULTS: At baseline, 29.9%, 22.1%, 20.6%, and 27.5% of subjects had SBP < 120, 120-129, 130-139, and ≥ 140 mmHg, respectively. Only 405 subjects developed ESRD. After 1 year, SBP was lowered, unchanged, and elevated in 20.8%, 54.3%, and 24.9% of subjects, respectively. Compared to the subjects with SBP < 120 mmHg both at baseline and the second measurement, there was no significant risk of ESRD in those who had SBP < 130 mmHg both at baseline and 1-3 years and or those with baseline SBP 130-139 mmHg and 1- to 3-year SBP < 140 mmHg. Subjects with baseline SBP 120-129 mmHg and 1- and 2-year SBP ≥ 130 mmHg were not significant (1.51 [0.86-2.66] and 1.73 [0.95-3.15], respectively) but 3-year SBP ≥ 130 mmHg had a significant ESRD risk (2.37 [1.23-4.56]). Subjects with baseline SBP ≥ 130 mmHg and 1- to 3-year SBP ≥ 140 mmHg had significant ESRD risk. CONCLUSION: Subjects with SBP < 130 mmHg at baseline and 1-3 years showed no significant risk of developing ESRD, in the general population.
BACKGROUND: The appropriate blood pressure target to prevent end-stage renal disease (ESRD) is controversial. METHODS: We examined the association between systolic blood pressure (SBP) changes and ESRD incidence in 69,575 participants from the Okinawa general population aged ≥ 20 years who underwent health check-ups in 1993 and more than once in 1994-1996. ESRD incidence was identified using dialysis registry until 2011. Cox proportional hazards model was used to estimate hazard ratio (95% confidence interval) with confounding factor adjustment. RESULTS: At baseline, 29.9%, 22.1%, 20.6%, and 27.5% of subjects had SBP < 120, 120-129, 130-139, and ≥ 140 mmHg, respectively. Only 405 subjects developed ESRD. After 1 year, SBP was lowered, unchanged, and elevated in 20.8%, 54.3%, and 24.9% of subjects, respectively. Compared to the subjects with SBP < 120 mmHg both at baseline and the second measurement, there was no significant risk of ESRD in those who had SBP < 130 mmHg both at baseline and 1-3 years and or those with baseline SBP 130-139 mmHg and 1- to 3-year SBP < 140 mmHg. Subjects with baseline SBP 120-129 mmHg and 1- and 2-year SBP ≥ 130 mmHg were not significant (1.51 [0.86-2.66] and 1.73 [0.95-3.15], respectively) but 3-year SBP ≥ 130 mmHg had a significant ESRD risk (2.37 [1.23-4.56]). Subjects with baseline SBP ≥ 130 mmHg and 1- to 3-year SBP ≥ 140 mmHg had significant ESRD risk. CONCLUSION: Subjects with SBP < 130 mmHg at baseline and 1-3 years showed no significant risk of developing ESRD, in the general population.
Entities:
Keywords:
Blood pressure; End-stage renal disease; Epidemiology; General population; Hypertension
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