Prehypertension and Incidence of ESRD
Prehypertension and Incidence of ESRD
Background Studies of the association of prehypertension with the incidence of end-stage renal disease (ESRD) after adjusting for other cardiovascular risk factors have shown controversial results.
Study Design Systematic review and meta-analysis of prospective cohort studies.
Setting & Population Adults with prehypertension.
Selection Criteria for Studies Studies evaluating the association of prehypertension with the incidence of ESRD identified by searches in PubMed, EMBASE, and Cochrane Library databases and conference proceedings, without language restriction.
Predictor Prehypertension.
Outcomes The relative risks (RRs) of ESRD were calculated and reported with 95% CIs. Subgroup analyses were conducted according to blood pressure (BP), age, sex, ethnicity, and study characteristics.
Results Data from 1,003,793 participants were derived from 6 prospective cohort studies. Compared with optimal BP, prehypertension significantly increased the risk of ESRD (RR, 1.59; 95% CI, 1.39–1.91). In subgroup analyses, prehypertension significantly predicted higher ESRD risk across age, sex, ethnicity, and study characteristics. Even low-range (BP, 120–129/80–84 mm Hg) prehypertension increased the risk of ESRD compared with optimal BP (RR, 1.44; 95% CI, 1.19–1.74), and the risk increased further with high-range (BP, 130–139/85–89 mm Hg) prehypertension (RR, 2.02; 95% CI, 1.70–2.40). The RR was significantly higher in the high-range compared with the low-range prehypertensive population (P = 0.01).
Limitations No access to individual patient-level data.
Conclusions Prehypertension is associated with incident ESRD. The increased risk is driven largely by high-range prehypertension.
The incidences of chronic kidney disease (CKD) and end-stage renal disease (ESRD) are increasing and represent a major worldwide public health problem. It has been reported that CKD affects 10%-15% of the adult population worldwide. People with CKD have decreased life expectancy, and those with ESRD who are receiving hemodialysis have a 20-fold higher mortality rate than that of age- and sex-matched individuals with normal kidney function. Accordingly, identification and treatment of risk factors for CKD should be a public health priority.
Prehypertension, which is defined in the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7), is associated with a risk of developing hypertension and also is related to cardiovascular disease morbidity and mortality. Data from cross-sectional studies also have shown that prehypertension, particularly high-range normal blood pressure (BP), is associated with CKD and ESRD. However, it is difficult to establish the detrimental effects of prehypertension on the kidneys from cross-sectional studies because kidney diseases per se can elevate BP. Some prospective cohort studies have indicated that prehypertension is related to the incidence of ESRD, whereas other studies have shown that the association is not statistically significant. The differences in results among these studies may be explained by the incidence rate of ESRD being low; thus, small and short-term studies fail to show this association. Furthermore, arguments against using the term prehypertension also include the fact that there is inhomogeneity within this category; the risk of progression to hypertension and development of cardiovascular disease is higher in individuals with BP of 130–139/85–89 mm Hg (high-range prehypertension) than in those with BP of 120–129/80–84 mm Hg (low-range prehypertension). This inhomogeneity also may be present in the association between prehypertension and CKD.
Given these inconsistent results, a systematic review and meta-analysis of prospective cohort studies that examined the association of prehypertension with ESRD risk may help clarify this issue. The objective of the present study was to evaluate the association of prehypertension with the incidence of ESRD.
Abstract and Introduction
Abstract
Background Studies of the association of prehypertension with the incidence of end-stage renal disease (ESRD) after adjusting for other cardiovascular risk factors have shown controversial results.
Study Design Systematic review and meta-analysis of prospective cohort studies.
Setting & Population Adults with prehypertension.
Selection Criteria for Studies Studies evaluating the association of prehypertension with the incidence of ESRD identified by searches in PubMed, EMBASE, and Cochrane Library databases and conference proceedings, without language restriction.
Predictor Prehypertension.
Outcomes The relative risks (RRs) of ESRD were calculated and reported with 95% CIs. Subgroup analyses were conducted according to blood pressure (BP), age, sex, ethnicity, and study characteristics.
Results Data from 1,003,793 participants were derived from 6 prospective cohort studies. Compared with optimal BP, prehypertension significantly increased the risk of ESRD (RR, 1.59; 95% CI, 1.39–1.91). In subgroup analyses, prehypertension significantly predicted higher ESRD risk across age, sex, ethnicity, and study characteristics. Even low-range (BP, 120–129/80–84 mm Hg) prehypertension increased the risk of ESRD compared with optimal BP (RR, 1.44; 95% CI, 1.19–1.74), and the risk increased further with high-range (BP, 130–139/85–89 mm Hg) prehypertension (RR, 2.02; 95% CI, 1.70–2.40). The RR was significantly higher in the high-range compared with the low-range prehypertensive population (P = 0.01).
Limitations No access to individual patient-level data.
Conclusions Prehypertension is associated with incident ESRD. The increased risk is driven largely by high-range prehypertension.
Introduction
The incidences of chronic kidney disease (CKD) and end-stage renal disease (ESRD) are increasing and represent a major worldwide public health problem. It has been reported that CKD affects 10%-15% of the adult population worldwide. People with CKD have decreased life expectancy, and those with ESRD who are receiving hemodialysis have a 20-fold higher mortality rate than that of age- and sex-matched individuals with normal kidney function. Accordingly, identification and treatment of risk factors for CKD should be a public health priority.
Prehypertension, which is defined in the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7), is associated with a risk of developing hypertension and also is related to cardiovascular disease morbidity and mortality. Data from cross-sectional studies also have shown that prehypertension, particularly high-range normal blood pressure (BP), is associated with CKD and ESRD. However, it is difficult to establish the detrimental effects of prehypertension on the kidneys from cross-sectional studies because kidney diseases per se can elevate BP. Some prospective cohort studies have indicated that prehypertension is related to the incidence of ESRD, whereas other studies have shown that the association is not statistically significant. The differences in results among these studies may be explained by the incidence rate of ESRD being low; thus, small and short-term studies fail to show this association. Furthermore, arguments against using the term prehypertension also include the fact that there is inhomogeneity within this category; the risk of progression to hypertension and development of cardiovascular disease is higher in individuals with BP of 130–139/85–89 mm Hg (high-range prehypertension) than in those with BP of 120–129/80–84 mm Hg (low-range prehypertension). This inhomogeneity also may be present in the association between prehypertension and CKD.
Given these inconsistent results, a systematic review and meta-analysis of prospective cohort studies that examined the association of prehypertension with ESRD risk may help clarify this issue. The objective of the present study was to evaluate the association of prehypertension with the incidence of ESRD.
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