Abstract P019: Association Between Hypertension and Kidney Function Trajectory: The Atherosclerosis Risk in Communities Study
Introduction: Cardiovascular disease, including hypertension, increases the risk of kidney disease progression. The relationship between hypertension and change in kidney function has not been fully elucidated. We hypothesized that hypertension is associated with faster kidney function decline.
Methods: Hypertension status was assessed among Atherosclerosis Risk in Communities (ARIC) Study participants at baseline (1987-89) and defined as systolic blood pressure ≥140, diastolic blood pressure ≥90, or anti-hypertensive medication use in the last two weeks. Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimated glomerular filtration rate (eGFR) was calculated using creatinine measured at baseline and follow-up study visits (1990-92; 1996-98; 2011-13) and an eGFR value of 15 mL/min/1.73 m2 was imputed for incident end-stage renal disease cases.
Results: After excluding those with missing baseline measurements of blood pressure, missing serum creatinine, and prevalent end-stage renal disease, there were 15,622 study participants. Baseline mean age was 55 years, 55% were female, 26% were black, and 35% had hypertension. Mean annual eGFR decline was 1.98 mL/min/1.73 m2 per year among those with hypertension and 1.54 mL/min/1.73 m2 per year among those without hypertension, after adjusting for demographic characteristics and co-morbidities (Figure, p<0.001). Participants with hypertension at baseline were more likely to develop chronic kidney disease than those without hypertension. Over 25 years, for those with hypertension and those without hypertension, respectively, the probability of developing chronic kidney disease stage 3A (eGFR <60 mL/min/1.73 m2) was 55.3% and 44.5%, stage 3B (eGFR <45 mL/min/1.73 m2) was 24.3% and 19.1%, stage 4 (eGFR <30 mL/min/1.73 m2) was 9.2% and 7.7%, and stage 5 (eGFR <15 mL/min/1.73 m2) was 3.9% and 3.5%.
Conclusion: Hypertension status was associated with faster kidney function decline. Absolute risk increase was greater for earlier kidney disease stages.
Author Disclosures: C.M. Rebholz: None. Y. Chen: None. K. Matsushita: None. J. Coresh: None. M.E. Grams: None.
- © 2015 by American Heart Association, Inc.