Published Online
on November 3, 2003

A more recent version of this article appeared on December 1, 2003

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Submitted on June 4, 2003
Revised on June 17, 2003

Effect of Blood Pressure on Early Decline in Kidney Function Among Hypertensive Men

Suma Vupputuri^*; Vecihi Batuman; Paul Muntner; Lydia A. Bazzano; John J. Lefante; Paul K. Whelton; and Jiang He

From the Departments of Epidemiology (S.V., P.M., L.A.B., P.K.W., J.H.) and Biostatistics (J.J.L.), Tulane University School of Public Health and Tropical Medicine; the Department of Medicine (V.B., P.K.W., J.H.), Tulane University School of Medicine; and the Veterans Administration Medical Center (V.B.), New Orleans, La.

^* To whom correspondence should be addressed. E-mail: suma{at}email.unc.edu.

Abstract--Few cohort studies have examined the longitudinal association between change in blood pressure and decline in kidney function among treated hypertensive patients without chronic kidney disease. We conducted a nonconcurrent cohort study to examine the effects of blood pressure on estimated glomerular filtration rate and early kidney function decline (rise in serum creatinine 0.6 mg/dL during follow-up) among 504 African-American and 218 white hypertensive patients. Our results showed that each standard deviation higher treated systolic (18 mm Hg) and diastolic (10 mm Hg) blood pressure was associated with an average annual decline (95% confidence interval [CI]) in estimated glomerular filtration rate of -0.92 ([-1.49 to -0.36] P=0.001) and -0.83 ([-1.38 to -0.28] P=0.003) mL · min^-1 · 1.73 m^-2, respectively, after adjustment for race, age, education, income, use of antihypertensive drugs, body mass index, and history of diabetes and dyslipidemia. Likewise, each standard deviation higher systolic and diastolic blood pressure was associated with relative risks (95% CIs) of 1.81 ([1.29 to 2.55] P<0.001) and 1.55 ([1.08 to 2.22] P=0.046), respectively, for early kidney function decline. Compared with patients with a blood pressure level <140/90 mm Hg, those with a blood pressure level 160/95 mm Hg had a -2.67 ([-4.01 to -1.32] P<0.001) mL · min^-1 · 1.73 m^-2 greater annual decline in estimated glomerular filtration rate and a 5.21-fold ([2.06 to 13.21] P<0.001) greater risk of early kidney function decline. Our study found that higher levels of treated blood pressure were positively and significantly related to early decline in kidney function among hypertensive men. These results indicate that better blood pressure control might prevent the onset of chronic kidney disease among hypertensives.

Key words: blood pressure • kidney failure • hypertension, detection and control • glomerular filtration rate • longitudinal studies

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