Association Between Hypertension and Kidney Function Decline: The Atherosclerosis Risk in Communities (ARIC) Study

Area of Science:

• Nephrology
• Cardiovascular Medicine
• Public Health

Background:

• Hypertension is a major risk factor for chronic kidney disease (CKD).
• The impact of hypertension and its treatment on kidney function decline over decades is not fully understood.
• Investigating the long-term effects of hypertension on estimated glomerular filtration rate (eGFR) is crucial for preventative strategies.

Purpose of the Study:

• To investigate the relationship between baseline hypertension status and the rate of change in estimated glomerular filtration rate (eGFR) over 30 years.
• To assess the influence of antihypertensive medication use on the association between hypertension and kidney function decline.
• To determine the 30-year predicted probabilities of developing CKD stage G3a+ across different hypertension categories.

Main Methods:

• Observational study utilizing data from 14,854 participants in the Atherosclerosis Risk in Communities (ARIC) Study.
• Baseline hypertension was categorized using 2017 ACC/AHA guidelines (normal BP, elevated BP, stage 1, stage 2 without medication, stage 2 with medication).
• Mixed-effects models analyzed the association between baseline hypertension and the slope of eGFR over 5 study visits across 30 years.

Main Results:

• Higher baseline blood pressure was associated with a faster annual eGFR decline compared to normal blood pressure.
• Individuals with stage 2 hypertension without medication showed the greatest eGFR decline (whites: -0.36 mL/min/1.73m²; African Americans: -0.50 mL/min/1.73m²).
• Predicted 30-year probabilities of developing CKD stage G3a+ were significantly higher in individuals with untreated stage 2 hypertension.

Conclusions:

• Baseline hypertension is linked to accelerated kidney function decline over 30 years in a general population.
• Antihypertensive medication use attenuated the rate of eGFR decline associated with hypertension.
• Effective blood pressure management is vital for preserving kidney function and preventing CKD progression.