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Longitudinal change in blood pressure and risk of end-stage renal disease in a community-based cohort in Okinawa

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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.

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Funding

This study was supported by Pfizer Health Research Foundation Grant.

Author information

Authors and Affiliations

  1. Division of Nephrology and Endocrinology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Tomoko Usui & Masaomi Nangaku

  2. Okinawa Heart and Renal Association, Clinical Research Support Center, Nakamura Clinic, Okinawa, Japan

    Chiho Iseki

  3. Clinical Research Support Center, Nakamura Clinic, Okinawa, Japan

    Kunitoshi Iseki

  4. Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan

    Tomoko Usui & Koji Kawakami

Authors
  1. Tomoko Usui
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  2. Chiho Iseki
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  3. Kunitoshi Iseki
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  4. Koji Kawakami
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  5. Masaomi Nangaku
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Corresponding author

Correspondence to Tomoko Usui.

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Conflict of interest

Advisory role: KK (Shin Nippon Biomedical Laboratories); stock ownership: KK (School Health Record Center, Real World Data); honoraria and manuscript fee: MN (Kyowa Hakko Kirin, Daiichi Sankyo, MSD KK, Astellas Pharma, Mitsubishi Tanabe Pharma); research funding: scholarship or donation: KK (Olympus, Bayer Yakuhin, Cmic, Novartis Pharma, Suntory Beverage & Food, Sumitomo Dainippon Pharma, Medical Platform, Stella Pharma, Amgen Astellas BioPharma), MN (Kyowa Hakko Kirin, Astellas Pharma, Bayer Yakuhin, Mitsubishi Tanabe Pharma, Daiichi Sankyo, Takeda). The remaining authors declare that they have no conflict of interest.

Human and animal rights (with IRB approval number)

This study was approved by the ethics committee of the Ethics Committee of Kyoto University Graduate School and Faculty of Medicine (R1332).

Informed consent

This study was performed according to Ethical Guidelines for Medical and Health Research Involving Human Subjects enacted by Ministry of Health, Labour and Welfare of Japan [26]. Due to the difficulty to obtain written or oral informed consent from the study subjects who participated between 1993 and 1996, and information provided from Okinawa Health Promotion Foundation was anonymized. According to the guidelines, the investigators are not necessarily required to obtain informed consent from the subjects.

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Usui, T., Iseki, C., Iseki, K. et al. Longitudinal change in blood pressure and risk of end-stage renal disease in a community-based cohort in Okinawa. Clin Exp Nephrol 23, 1280–1287 (2019). https://doi.org/10.1007/s10157-019-01771-0

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  • DOI: https://doi.org/10.1007/s10157-019-01771-0

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