Long-term blood pressure variability, new-onset diabetes mellitus, and new-onset chronic kidney disease in the Japanese general population

Yuichiro Yano, Shouichi Fujimoto, Holly Kramer, Yuji Sato, Tsuneo Konta, Kunitoshi Iseki, Chiho Iseki, Toshiki Moriyama, Kunihiro Yamagata, Kazuhiko Tsuruya, Ichiei Narita, Masahide Kondo, Kenjiro Kimura, Koichi Asahi, Issei Kurahashi, Yasuo Ohashi, Tsuyoshi Watanabe

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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 48 587 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.

Original languageEnglish
Pages (from-to)30-36
Number of pages7
JournalHypertension
Volume66
Issue number1
DOIs
Publication statusPublished - Jul 4 2015

All Science Journal Classification (ASJC) codes

  • Internal Medicine

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    Yano, Y., Fujimoto, S., Kramer, H., Sato, Y., Konta, T., Iseki, K., Iseki, C., Moriyama, T., Yamagata, K., Tsuruya, K., Narita, I., Kondo, M., Kimura, K., Asahi, K., Kurahashi, I., Ohashi, Y., & Watanabe, T. (2015). Long-term blood pressure variability, new-onset diabetes mellitus, and new-onset chronic kidney disease in the Japanese general population. Hypertension, 66(1), 30-36. https://doi.org/10.1161/HYPERTENSIONAHA.115.05472