Abstract
BackgroundAssociation between blood pressure (BP) and kidney function among the middle and old aged general population without hypertension remains unclear.MethodsParticipants aged ≥ 45 years, with complete data in 2011 and 2015 interviews of the China Health and Retirement Longitudinal Study(CHARLS), and without pre-existing hypertension were included. Systolic BP (SBP) was categorized as low (< 120 mmHg), medium (120–129 mmHg), and high (120–139 mmHg). Diastolic BP (DBP) was categorized as low (< 60 mmHg), medium (60–74 mmHg), and high (75–89 mmHg). Pulse pressure (PP) was categorized as normal (< 60 mmHg) and high (≥ 60 mmHg). The outcome was defined as rapid decline of estimated glomerular filtration rate(eGFR, decline ≥ 4 ml/min/1.73 m2/year). BP combination was designed according to the category of SBP and PP. The association between BP components, types of BP combination, and the risk of rapid decline of eGFR was analyzed using multivariate logistic regression models, respectively. Age-stratified analyses were conducted.ResultsOf 4,534 participants included, 695(15.3%) individuals were recognized as having rapid decline of eGFR. High PP[odds ratio(OR) = 1.34, 95%confidence interval(CI) 1.02–1.75], low SBP (OR = 1.28, 95%CI 1.03–1.59), and high SBP (OR = 1.32, 95% CI 1.02–1.71) were significantly associated with the risk of eGFR decline. Low SBP were associated with 65% increment of the risk of eGFR decline among participants aged < 55 years. The combination of high SBP and high PP (OR = 1.79, 95% CI 1.27–2.54) and the combination of low SBP and high PP (OR = 3.07, 95% CI 1.24–7.58) were associated with the increased risk of eGFR decline among the middle and old aged general population.ConclusionSingle and combination of high PP and high SBP could be the risk indicators of eGFR decline among the middle and old aged general population.
Highlights
Association between blood pressure (BP) and kidney function among the middle and old aged general population without hypertension remains unclear
Higher levels of Pulse pressure (PP) were observed among the participants with higher levels of Systolic BP (SBP) and lower levels of Diastolic BP (DBP). (P < 0.001) (Fig. 2) Compared with those having Estimated glomerular filtration rate (eGFR) ≥ 90 ml/min/1.73m2, significantly higher levels of PP and SBP were observed among participants with lower levels of eGFR. (P < 0.001) No significant difference of the levels of DBP was observed among participants with different levels of eGFR. (P > 0.05) (Table 1)
Participants with high PP showed significantly lower levels of eGFR at baseline and at the endpoint. (P < 0.001) Much severe annual decline of eGFR and more cases of rapid decline of eGFR were found among participants with high PP. (P < 0.05) Compared with participants with low or medium SBP, participants with high SBP showed significantly lower levels of eGFR both at baseline and at the endpoint. (P < 0.001) Participants with low DBP showed lower levels of eGFR at the endpoint and much severe annual decline of eGFR. (P < 0.05) (Table 2)
Summary
Association between blood pressure (BP) and kidney function among the middle and old aged general population without hypertension remains unclear. Less than 5% of patients in the early stages of CKD were aware of their disease [7]. As to the population having comorbidities related to CKD, such as hypertension, the control of the comorbidity is the modifiable risk indicator for the decline of kidney function. An effective risk indicator for the early risk-recognition of decline in kidney function among the middle and old aged general population is urgently needed. With consideration of the feature of general population who are less tending to receive invasive and costly examination in clinics, an accessible, pragmatic and cost-saving approach would be feasible for the risk recognition and monitor among the middle and old aged general population
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