Abstract
Several recent clinical trials and meta-analyses have shown that lowering blood pressure reduces the risk of cardiovascular disease. However, current evidence that describes general demographics in blood pressure and mortality with chronic kidney disease is sparse in Japan. Using a population-based longitudinal cohort that received annual health checkups in Japan in 2008, hypertensive status, self-reported use of antihypertensive drugs, and prognosis were examined through 2012. Chronic kidney disease was defined as positive proteinuria or estimated glomerular filtration rate <60 ml/min/1.73 m2. Subjects were 40 to 74 years old (n = 227,204) with median 3.6 years follow-up period, and patients with and without chronic kidney disease were analyzed separately (n = 183,586 and n = 43,618, respectively). Cardiovascular disease mortality, comprising coronary heart diseases and stroke as entered in the national death registry using ICD-10 coding, was examined. Among all subjects, 346 deaths (96 in chronic kidney disease and 250 in non-chronic kidney disease) due to cardiovascular disease occurred. Compared with cardiovascular disease mortality in chronic kidney disease patients with untreated normal blood pressure, the multivariable adjusted hazard ratio was 3.08 (95% confidence interval: 1.75-5.41) for those with untreated hypertension, 2.30 (1.31-4.03) for those who became normotensive after treatment, and 3.28 (1.91-5.64) for those who remained hypertensive despite treatment. In non-chronic kidney disease subjects, the ratios were 1.90 (1.33-5.41), 1.95 (1.35-2.80), and 1.77 (1.18-2.66), respectively. These results from a nationwide cohort could be one of representative demographics of controlling blood pressure and cardiovascular disease deaths when treating patients with chronic kidney disease in Japan in recent years. Even after development and spread of anti-hypertensive drugs, preventing development of hypertension is preferable, because any hypertension treatment status comparing untreated normal blood pressure was a risk of cardiovascular mortality at baseline year.
Highlights
High blood pressure (BP) confers a risk of cardiovascular disease (CVD) [1,2,3]
Compared with subjects with untreated, normal BP at baseline, untreated hypertensive subjects were a mean of 2.4 years older, and the treated population was 5.5 years older on average; in addition, body mass index (BMI) was higher in hypertensive subjects, regardless of treatment category
EGFR was 1.3 ml/ min/1.73 m2 lower in the subpopulation with untreated hypertension and 5 ml/min/1.73 m2 lower in subjects who remained hypertensive despite treatment, compared with that of subjects with untreated normal BP
Summary
High blood pressure (BP) confers a risk of cardiovascular disease (CVD) [1,2,3]. Compared with the general population, patients with chronic kidney disease (CKD) have a high risk of CVD mortality [4]. Of 31 BP-lowering trials assessing different BP targets, only 6 studies selected cohorts that included CKD patients [16,17,18,19,20,21], whereas studies defined no-CKD cohorts, and the remaining did not report the renal function of their cohorts. These results indicate the rarity of longitudinal cohorts that include a well-identified CKD population for assessing CVD mortality
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