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Hypertension. 2015 Jul;66(1):30-6. doi: 10.1161/HYPERTENSIONAHA.115.05472. Epub 2015 May 18.

Long-Term Blood Pressure Variability, New-Onset Diabetes Mellitus, and New-Onset Chronic Kidney Disease in the Japanese General Population.

Author information

1
From the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y.); Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine (S.F.) and Dialysis Division, University of Miyazaki Hospital (Y.S.), University of Miyazaki, Miyazaki, Japan; Department of Public Health Sciences (H.K.) and Division of Nephrology and Hypertension (H.K.), Loyola Medical Center, Maywood, IL; Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan (T.K.); Dialysis Unit, University Hospital of the Ryukyus, Okinawa, Japan (K.I., C.I.); Health Care Center, Osaka University, Osaka, Japan (T.M.); Department of Nephrology (K.Y.) and Department of Health Care Policy and Health Economics (M.K.), Faculty of Medicine, University of Tsukuba, Ibarak, Japan; Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan (K.T.); Division of Clinical Nephrology and Rheumatology, Niigata University Medical School, Nigata, Japan (I.N.); Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan (K.K.); Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism, School of Medicine, Fukushima Medical University, Fukushima, Japan (K.A., T.W.); iAnalysis LLC, Tokyo, Japan (K.I); and Department of Integrated Science and Engineering for Sustainable Society, Chuo University, Tokyo, Japan (Y.O.). yyano@jichi.jp fujimos@med.miyazaki-u.ac.jp.
2
From the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y.); Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine (S.F.) and Dialysis Division, University of Miyazaki Hospital (Y.S.), University of Miyazaki, Miyazaki, Japan; Department of Public Health Sciences (H.K.) and Division of Nephrology and Hypertension (H.K.), Loyola Medical Center, Maywood, IL; Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan (T.K.); Dialysis Unit, University Hospital of the Ryukyus, Okinawa, Japan (K.I., C.I.); Health Care Center, Osaka University, Osaka, Japan (T.M.); Department of Nephrology (K.Y.) and Department of Health Care Policy and Health Economics (M.K.), Faculty of Medicine, University of Tsukuba, Ibarak, Japan; Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan (K.T.); Division of Clinical Nephrology and Rheumatology, Niigata University Medical School, Nigata, Japan (I.N.); Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan (K.K.); Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism, School of Medicine, Fukushima Medical University, Fukushima, Japan (K.A., T.W.); iAnalysis LLC, Tokyo, Japan (K.I); and Department of Integrated Science and Engineering for Sustainable Society, Chuo University, Tokyo, Japan (Y.O.).

Abstract

Whether long-term blood pressure (BP) variability among individuals without diabetes mellitus is associated with new-onset chronic kidney disease (CKD) risk, independently of other BP parameters (eg, mean BP, cumulative exposure to BP) and metabolic profile changes during follow-up, remains uncertain. We used data from a nationwide study of 48‚ÄČ587 Japanese adults aged 40 to 74 years (mean age, 61.7 years; 39% men) without diabetes mellitus or CKD (estimated glomerular filtration rate <60 mL/min per 1.73 m2 or proteinuria by dipstick). BP was measured at baseline and during 3 annual follow-up visits (4 visits). BP variability was defined as standard deviation (SD) and average real variability during the 4 visits. At the year 3 follow-up visit, 6.3% of the population had developed CKD. In multivariable-adjusted logistic regression models, 1 SD increases in SDSBP (per 5 mmHg), SDDBP (per 3 mmHg), average real variabilitySBP (per 6 mmHg), and average real variabilityDBP (per 4 mmHg) were associated with new-onset CKD (odds ratios [ORs] and 95% confidence intervals, 1.15 [1.11-1.20], 1.08 [1.04-1.12], 1.13 [1.09-1.17], 1.06 [1.02-1.10], respectively; all P<0.01) after adjustment for clinical characteristics, and with mean BP from year 0 to year 3. The associations of SDBP and average real variabilityBP with CKD remained significant after additional adjustments for metabolic parameter changes during follow-up (ORs, 1.06-1.15; all P<0.01). Sensitivity analyses by sex, antihypertensive medication use, and the presence of hypertension showed similar conclusions. Among those in the middle-aged and elderly general population without diabetes mellitus, long-term BP variability during 3 years was associated with new-onset CKD risk, independently of mean or cumulative exposure to BP and metabolic profile changes during follow-up.

KEYWORDS:

blood pressure; chronic renal disease; diabetes mellitus; epidemiology

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