Abstract
Introduction Hypertension, particularly pulse pressure [PP] is a major risk factor for end-stage renal disease. However, the effect of individual components of hypertension namely PP, systolic [SBP] and diastolic blood pressure [DBP] on kidney function, in the general African population is unknown. Methods Data were collected on 944 participants [aged 40-75 y], living in villages in the area around the city of Kumasi, Ghana, on demographics, medications, height, weight, BP and 24-hour creatinine clearance (CrCl). Results The demographic and clinical characteristics were: age 55(11) [mean (SD)] years, females 62%, rural village-dwellers 52%, diabetes 1·5%, BMI 21(4) kg/m2, 24-hourCrCl as a measure of glomerular filtration rate (GFR) 84(23) ml/min/1.73 m2. 29% had BP >140/90 mmHg; SBP and DBP were 125/74(26/14) mmHg, PP was 51(17) mmHg. PP increased with age by 0.55(95% CI: 0.46,0.64) mmHg/year. PP was higher (53(17) v 49(15) mmHg; p < 0.001) in the semiurban participants. GFR decreased both with increasing PP [-0.19 (-0.27,-0.10 ml/min/1.73 m2/mmHg; p < 0.001] and SBP [-0.09 (-0.14,-0.03) ml/min/1.73 m2/mmHg; p < 0.001] but there was no significant relationship with DBP [-0.04 (-0.15,0.06)]. After adjusting for SBP, the relationship between GFR and PP became steeper [-0.31 (-0.50,-0.12) ml/min/1.73 m2/mmHg; p < 0.001]. Using multivariate regression analysis that included PP, age, gender, BMI, only increasing age [-0.75 (-0.88,-0.62)] and decreasing BMI [0.49 (0.16,0.81)] were associated with decreased kidney function. Conclusions In this homogeneous West-African population, PP increased with age and had a steeper relationship with declining kidney function than SBP or DBP.
Highlights
Hypertension, pulse pressure [PP] is a major risk factor for end-stage renal disease
glomerular filtration rate (GFR) decreased both with increasing PP [-0.19 (-0.27,0.10 ml/min/1.73 m2/mmHg; p < 0.001] and SBP [-0.09 (-0.14,0.03) ml/min/1.73 m2/mmHg; p < 0.001] but there was no significant relationship with diastolic blood pressure (DBP) [-0.04 (-0.15,0.06)]
In a predominantly Caucasian population with early and predialysis chronic kidney disease (CKD), we have found a strong relationship between PP and progression of chronic kidney disease, onset of dialysis, and death [2, 10]
Summary
Hypertension, pulse pressure [PP] is a major risk factor for end-stage renal disease. The effect of individual components of hypertension namely PP, systolic [SBP] and diastolic blood pressure [DBP] on kidney function, in the general African population is unknown. In this homogeneous West-African population, PP increased with age and had a steeper relationship with declining kidney function than SBP or DBP. Hypertension is a major risk factor for chronic kidney damage, and while both systolic (SBP) and diastolic blood pressure (DBP) have been implicated as causal factors, it is clear that SBP is a much stronger predictor of chronic kidney disease than DBP [1,2,3]. PP has a stronger relationship than SBP alone with cardiovascular deaths in end-stage renal disease (ESRD) patients [3, 8, 9]. In a predominantly Caucasian population with early and predialysis chronic kidney disease (CKD), we have found a strong relationship between PP and progression of chronic kidney disease, onset of dialysis, and death [2, 10]
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