Blood Pressure Predicts Risk of Developing End-Stage Renal Disease in Men and Women

Abstract

Abstract-Blood pressure as a risk factor for development of end-stage renal disease has not been fully studied, particularly in women. We studied the development of end-stage renal disease from 1983 through 2000 in 98 759 subjects, 46 881 men and 51 878 women, 20 to 98 years of age, who were screened in 1983 in Okinawa, Japan. Data for all dialysis patients registered from 1983 to 2000 in Okinawa were used to identify the screened subjects in whom end-stage renal disease developed. In follow-up, 400 subjects, 231 men and 169 women, had end-stage renal disease. Age, body mass index, and adjusted relative risk for systolic and diastolic blood pressure for both men and women were measured. When these results were compared with an optimal blood pressure, the relative risk of development of end-stage renal disease for those with high-normal blood pressure and hypertension were significant in both men and women. Hypertension is a significant risk factor for development of end-stage renal disease not only in men but also in women. Control of blood pressure within normal levels should be stressed as a strategy to prevent end-stage renal disease in both men and women. Key Words: blood pressure Ⅲ epidemiology Ⅲ kidney failure Ⅲ risk factors Ⅲ women T he number of new dialysis patients is increasing annually, and the reasons for this increase are not clear. The prevalence of dialysis patients was 1752 per million persons in Okinawa, Japan. 1 Higher blood pressure was a significant predictor of end-stage renal disease (ESRD) in hypertensive men. 2 In men screened for the Multiple Risk Factor Intervention Trial, high-normal and high blood pressure were judged to be strong independent risk factors for ESRD. 3 However, these data concerned men only 2,3 or were not stratified by gender. 4 We previously reported from the 10-year follow-up of a screened cohort in Okinawa that high diastolic blood pressure (DBP) was a significant predictor of ESRD but that systolic blood pressure (SBP) was not. 4 In the current study, we extended the follow-up period in our cohort by 6 years and prospectively studied the development of ESRD in 46 876 men and 51 878 women screened by the Okinawa General Health Maintenance Association in 1983; we also examined the effect of blood pressure on the risk of development of ESRD in women. Methods Study DesignAll individuals who were from 20 to 98 years of age and who participated in the 1983 mass health screening examination in Okinawa, Japan, were eligible for the study. Dialysis patients who had been among the 1983 mass screening participants and who became dialysis patients from 1983 to 2000 were identified through the Okinawa Dialysis Study (OKIDS) registry. 1 Furthermore, patient identification was verified by reviewing the medical records of the dialysis unit. The cumulative incidence of ESRD and the relative risk (RR) of developing ESRD according to blood pressure levels taken from the mass screening registry were determined. Mass Screening RegistryThe large community-based health examination progr...

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High-normal blood pressure is associated with microalbuminuria in the general population: the Watari study

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Blood Pressure, Proteinuria, and Phosphate as Risk Factors for Progressive Kidney Disease: A Hypothesis

“…10,11 An increased risk of ESRD beginning at the third quintile of systolic and diastolic blood pressure (127/82 mm Hg) was evident in 332,544 middle-aged men in the Multiple Risk Factor Intervention Trial (MRFIT), 10 and blood pressure values higher than high normal were associated with a progressive increase in risk of ESRD in the Okinawa mass screening program (n ϭ 98,759). 11 There is a large body of evidence that blood pressure reduction may slow GFR loss and reduce cardiovascular outcomes. 12 However, 2 crucial issues in the management of hypertension in patients with CKD are first, whether a specific blood pressure target may maximize renoprotection, and second, whether a specific drug may be beneficial, independent of blood pressure control.…”

“…Concerning blood pressure targets, few randomized trials [13][14][15][16] have been conducted in patients with CKD to confirm the association of findings from these cohort studies. 10,11 In the Modification of Diet in Renal Disease (MDRD) Study, the largest randomized prospective trial performed to date (840 patients, mostly with nondiabetic kidney disease), tight blood pressure control (mean arterial pressure Յ92 mm Hg; ie, blood pressure, 125/75 mm Hg) did not improve the primary outcome of GFR reduction, doubling of serum creatinine level, or ESRD. 13 However, intensive control slowed the progression of CKD when protein excretion Ͼ1 g/d, 17 although the greater benefits in GFR decline in these patients may be explained in part by the greater use of angiotensin-converting enzyme (ACE) inhibitors.…”