Changes in Blood Pressure During Young Adulthood and Subsequent Kidney Function Decline: Findings From the Coronary Artery Risk Development in Young Adulthood (CARDIA) Study - PubMed (original) (raw)

Changes in Blood Pressure During Young Adulthood and Subsequent Kidney Function Decline: Findings From the Coronary Artery Risk Development in Young Adulthood (CARDIA) Study

Elaine Ku et al. Am J Kidney Dis. 2018 Aug.

Abstract

Background: Many studies have focused on the association between a single blood pressure (BP) measurement and risk for adverse outcomes. However, the association of BP trajectories during young adulthood with subsequent decline in kidney function has not been well defined.

Study design: Observational cohort study.

Setting & participants: 3,429 participants in the Coronary Artery Risk Development in Young Adulthood (CARDIA) Study enrolled between the ages of 18 and 30 years.

Predictors: BP slope during the first 10 years of participation in CARDIA, derived from linear mixed models incorporating all repeated BP measures.

Outcome: Decline in estimated glomerular filtration rate (eGFR) during the interval between years 10 and 20 of CARDIA participation using cystatin C measured at years 10, 15, and 20.

Results: Mean age of CARDIA participants at year 0 was 25.1 years, 56% were women, and 53% were white. Every 10-mmHg higher level of systolic (SBP) and diastolic BP (DBP) in year 10 was associated with change in eGFR of -0.09 (95% CI, -0.13 to -0.06) and -0.07 (95% CI, -0.12 to -0.03) mL/min/1.73m2 per year, respectively. Every 10-mmHg increase in SBP slope between years 0 and 10 was associated with a subsequent -0.52 (95% CI, -1.02 to -0.03) mL/min/1.73m2 per year change in kidney function after adjustment for comorbid conditions and SBP at year 10. Similarly, every 10-mmHg increase in DBP slope between years 0 and 10 was associated with a subsequent change in kidney function of -0.65 (95% CI, -1.23 to -0.07) mL/min/1.73m2 per year, after adjustment for comorbid conditions and DBP in year 10.

Limitations: Observational design.

Conclusions: During young adulthood, increasing SBP and DBP are associated with a higher rate of subsequent kidney function decline, independent of BP measured at the beginning of eGFR assessment.

Keywords: BP slope; Blood pressure; DBP; SBP; eGFR trajectory; estimated glomerular filtration rate (eGFR); hypertension; kidney function; modifiable risk factor; renal outcome; young adulthood.

Copyright © 2018 National Kidney Foundation, Inc. All rights reserved.

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Figures

Figure 1

Figure 1

Study design and approach in A) primary analysis and B) sensitivity analysis using a time-updated approach. *In this approach, BP between years 5–10 will predict eGFR decline between years 10–15, and BP between years 10–15 will predict eGFR decline between years 15–20. BLUP = best linear unbiased predictor

Figure 2

Figure 2

Distribution of SBP and DBP slopes (in mm Hg) per 5 years between years 0–10.

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