Abstract 12489: Association of Longitudinal Blood Pressure Changes and Kidney Function Decline: Findings From the Multi-Ethnic Study of Atherosclerosis

Abstract

Background: Few studies have examined the association of blood pressure (BP) change over time with kidney function decline. We hypothesized that increasing systolic blood pressure (SBP), decreasing diastolic blood pressure (DBP), and widening pulse pressure (PP) trajectory would be associated with worsening renal function, independent of baseline BP, among persons with relatively preserved estimated glomerular filtration rate (eGFR) and free from cardiovascular disease at baseline. Methods: We used data from 4,156 participants in the MESA Study who had at least two BP measurements from study year 0 to year 5 and eGFR measurements at year 5 and 10. Participants were then grouped into one of three groups based on the distribution of change (top 20% = increasers, middle 21-79% = stable, bottom 20% = decreasers). We calculated eGFR from cystatin C and defined rapid decline as a >30% decrease in eGFR. We used multivariable logistic regression adjusting for demographics, baseline eGFR and BP to determine associations of BP change category with later renal function decline. We also estimated the association of change in BP with annual change in eGFR using adjusted linear regression. Results: The stable SBP group had a mean age of 59, was 50% male, 41% white, and had 29% of participants on an anti-hypertensive medication. The increasing SBP group was similar except for having fewer men (43%). Median year 0 and year 5 SBP for increasing SBP was 110 and 131, for stable 119 and 118, for decreasing 145 and 119 mmHg respectively. Increasing SBP and widening PP trajectory were associated with higher odds of rapid renal function decline compared to stable groups after adjusting for all covariates including baseline BP. Decreasing SBP was not associated with rapid renal function decline after adjusting for baseline BP. Similar findings were seen with annual renal function decline. Implication: Increasing SBP and widening PP appears to increase the risk for accelerated kidney function decline.