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Intrarenal Renin-Angiotensin System Activation Alters Relationship Between Systolic Blood Pressure and Progression of

Cheol Ho Park1, Hyung Woo Kim1, Jung Tak Park1

  • 1Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea (C.H.P., H.W.K., J.T.P., T.-H.Y., S.-W.K., S.H.H.).

Hypertension (Dallas, Tex. : 1979)
|April 19, 2023
PubMed

Insights

High systolic blood pressure (SBP) increases chronic kidney disease (CKD) progression risk only when intrarenal renin-angiotensin system activity is low. Low urinary angiotensinogen indicates low activity, revealing SBP

Area of Science:

  • Nephrology
  • Cardiovascular Medicine
  • Biochemistry

Background:

  • Elevated blood pressure and intrarenal renin-angiotensin system (RAS) activity are linked to chronic kidney disease (CKD) progression.
  • The interplay between blood pressure and intrarenal RAS activity in predicting CKD progression risk remains unclear.

Purpose of the Study:

  • To investigate the combined effect of systolic blood pressure (SBP) and intrarenal RAS activity on the risk of CKD progression.
  • To determine if urinary angiotensinogen levels modify the association between SBP and adverse kidney outcomes in CKD patients.

Main Methods:

  • Analysis of 2076 participants from the Korean Cohort Study for Outcomes in Patients With CKD.
  • Systolic blood pressure (SBP) as the primary exposure.
  • Stratification of urinary angiotensinogen-to-creatinine ratio (UACR) by median value (3.65 μg/gCr).
  • Primary outcome: composite of ≥50% estimated glomerular filtration rate decline or initiation of kidney replacement therapy.

Main Results:

  • Higher SBP was associated with an increased risk of CKD progression over 10,550 person-years of follow-up.
  • A significant interaction (P=0.019) was observed between SBP and UACR regarding CKD progression risk.
  • In patients with low UACR (<3.65 μg/gCr), higher SBP levels (≥140 mmHg) significantly increased CKD progression risk (HR 2.40; 95% CI 1.73-3.32).
  • This association between higher SBP and CKD progression was not observed in patients with high UACR (≥3.65 μg/gCr).

Conclusions:

  • Higher SBP is linked to CKD progression primarily when intrarenal RAS activity, indicated by low urinary angiotensinogen, is low.
  • Intrarenal RAS activity appears to modify the relationship between SBP and adverse kidney outcomes in patients with CKD.
  • These findings highlight the importance of considering intrarenal RAS status in managing blood pressure for CKD patients.
Abstract

Keywords:
angiotensinogenblood pressureintrarenal renin-angiotensin systemrenal insufficiency, chronicurine

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