Blood pressure components and risk for chronic kidney disease in middle-aged Japanese men: The Kansai Healthcare Study

Abstract

It is unclear which blood pressure (BP) components (that is, systolic BP (SBP), diastolic BP (DBP), pulse pressure (PP) and mean arterial pressure (MAP)) are superior predictors of chronic kidney disease (CKD). Furthermore it is unclear whether the combination of SBP+DBP or PP+MAP is superior to any of these four individual BP components in predicting CKD. We enrolled 9928 Japanese men aged 40-55 years who had a normal estimated glomerular filtration rate (eGFR), no proteinuria and no history of cardiovascular disease and were not taking any antihypertensive medications at baseline. CKD was defined as an eGFR of o60 ml min À1 per 1.73 m 2 using the modified diet in renal disease equation. DAkaike's information criterion (DAIC) was used to compare the BP components-added model to the model without them in a Cox proportional hazards model. During the 52 428 person-years of follow-up, there were 434 cases of CKD. Of all four BP components, the model including DBP-or MAP-alone had the highest values of DAIC (10.2 and 9.85, respectively). The PP-alone model had the lowest DAIC value (À1.48). The combination models including SBP+DBP (DAIC 8.42) or PP+MAP (8.42) were not superior to the models including DBP-or MAP-alone. These findings suggested that, of the four BP components, both DBP and MAP were the most useful predictors for subsequent incidence of CKD, but PP was not an important predictor. The combination model, including SBP+DBP or PP+MAP, was not superior to the models including DBP-or MAP-alone for predicting CKD.

Drinking Pattern and Risk of Chronic Kidney Disease: The Kansai Healthcare Study

“…eGFR was estimated by the 3-variable Japanese equation, defined as follows: eGFR (ml/min/1.73 m 2 ) = 194 × serum creatinine -1.094 × age -0.287 [19]. After an approximate 5-min rest in a quiet room, systolic and diastolic blood pressures were measured in a sitting position with an automatic sphygmomanometer (BP-203RV; Omron Colin, Tokyo, Japan and Udex-super; ELK Corp., Osaka, Japan) [20]. Body mass index (BMI) was calculated as weight in kilograms divided by the square of the height in meters.…”

Ethnic differences in the association between blood pressure components and chronic kidney disease in middle aged and older Asian adults

“…Hypertension has consistently been shown to be an important risk factor for CKD in Western populations [7,8,13,33]. While majority of the studies involving Asian populations [19,34-36] have reported an association between hypertension and CKD, few studies involving Asian Chinese in the US [16], a large cohort of adults in Japan [21] and Korea [22] have documented no significant association of hypertension with CKD. Although hypertension has been shown to be an important risk factor for ESRD in the US general population, ethnic differences have been reported in the association between hypertension and ESRD with blacks having a 4–5 fold increased risk of hypertensive ESRD compared to whites [37,38].…”

“…While studies involving Western populations have shown a consistent positive association between systolic BP and CKD, the pattern of association of systolic BP with CKD has not been consistent in Asian populations. Systolic BP was shown to be strong predictor of ESRD in a large cohort of Chinese adults who participated in the China National Hypertension Survey Epidemiology Follow-up Study (CHEFS) [44] and in a large cohort of middle-aged Japanese men who participated in the Kansai Healthcare Study in Japan [19]. However, similar to our findings in Chinese and Indians, three cross-sectional studies involving Chinese [20], and Japanese [21,47] adults reported no significant association between systolic BP and CKD.…”

“…However, studies examining the association between BP and CKD in Asian populations have shown mixed results. While some studies involving Malays [18] and Japanese men [19] have reported an association between BP and CKD, some studies involving Chinese [20], Japanese [21] and Korean adults [22] have documented no significant association between BP and CKD. This inconsistency could partly be due to differences in methodology or population characteristics.…”

Elevated White Blood Cell Count Worsens Proteinuria but Not Estimated Glomerular Filtration Rate: The Kansai Healthcare Study

“…WBC count was measured by the flow cytometry method. After resting approximately 5 min in a quiet room, systolic and diastolic blood pressures were measured in a sitting position with an automatic sphygmomanometer (BP-203RV; Omron Colin, Tokyo, Japan; and Udex-super; ELK Corp., Osaka, Japan) [17]. Body mass index (BMI) was calculated as the weight in kilograms divided by the square of the height in meters.…”