Association of Adolescent Hypertension With Future End-stage Renal Disease

Abstract

IMPORTANCE Hypertension is a leading risk factor of cardiovascular morbidity and mortality. The role of nonmalignant hypertension as the sole initiating factor of end-stage renal disease (ESRD) in non-African American populations has recently been questioned. OBJECTIVE To investigate the association between hypertension and future ESRD in otherwise healthy adolescents. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study examined the data of 16-to 19-year-old healthy candidates for military service in the Israel Defense Forces between January 1, 1967, and December 31, 2013. Data were obtained from the central conscription registry of the Israel Defense Forces and the ESRD registry of the Israel Ministry of Health. Participants underwent a comprehensive medical assessment prior to their military service. Individuals with evidence of renal damage or kidney-related risk factors were excluded. The data analysis was conducted from February 12, 2017, to October 16, 2018. MAIN OUTCOMES AND MEASURES End-stage renal disease as recorded by the Israeli ESRD registry, including hemodialysis, peritoneal dialysis, renal transplant diagnosed between January 1, 1990, and December 31, 2014. RESULTS The cohort included 2 658 238 adolescents (1 596 709 [60.1%] male with a mean [SD] age of 17.4 [0.5] years), of whom 7997 (0.3%) had an established hypertension diagnosis. Half of the individuals in the hypertensive group were overweight (1559 [20.1%]) or obese (2243 [28.9%]), and most (7235 [90.5%]) were male. During a median follow-up of 19.6 years (52 287 945 person-years), 2189 individuals developed ESRD, with an incidence rate of 3.9 per 100 000 person-years. Adolescent hypertension was found to be associated with future ESRD (crude hazard ratio [HR], 5.07; 95% CI, 3.73-6.88). In a multivariable model adjusted for sex, age, years of education, body mass index, and other sociodemographic variables, the HR was 1.98 (95% CI, 1.42-2.77). When excluding participants with severe hypertension, the association with ESRD remained statistically significant (HR, 1.93; 95% CI, 1.37-2.70). In the subanalysis of nonoverweight adolescents, the association between hypertension and ESRD was statistically significant as well (HR, 2.11; 95% CI, 1.05-4.24). CONCLUSIONS AND RELEVANCE Hypertension appears to be associated with a doubling of the risk of future ESRD in an otherwise healthy adolescent population.

Sex Differences in Association of Elevated Blood Pressure with Variables Characterizing Cardiometabolic Risk in Young Subjects with or Without Metabolic Abnormalities

“…The relationship between BP and the kidney is complex, and each may adversely affect the other. Essential hypertension is an initiating risk factor for future end-stage renal disease, even in adolescents, regardless of their sex, and presence or absence of obesity [7]. On the other hand, an increase in arterial pressure is needed to maintain salt and water balance in the presence of restriction in renal perfusion, glomerular injury, and a reduced glomerular filtration rate [8].…”

Are There Consequences of Adolescent Blood Pressure on Kidney Function in Adulthood?

“…A recent study published in JAMA Internal Medicine by Leiba et al 3 investigated the association between hypertension in adolescents and future ESRD. This large population-based retrospective cohort study linked data from the conscription registry of the Israel Defense Forces with data from the Israel Ministry of Health ESRD registry.…”

More Evidence to Suggest a Relation of Blood Pressure to Long-term Progression of Kidney Disease: Is It Causal?

“…In an attempt to evaluate this question, the authors made the decision to only use the BP at the baseline visit as the exposure variable (rather than as a time-dependent variable), arguing that this maintains strict temporality between elevated BP and subsequent declines in eGFR. A relatively similar approach was taken by Leiba et al, 11 who found that hypertension (defined as BP > 140/80 mm Hg but <160/100 mm Hg) carried a nearly 2-fold greater risk for kidney failure over a median 20-year follow-up period in a cohort of more than 2 million healthy adolescent candidates for Israeli military service. The alternative methodological approach would be to incorporate BP over time and treat it as a timedependent variable.…”