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Cumulative blood pressure load and hypertensive nephropathy in Han Chinese hypertensive patients
Kuan-I Liu1,2, Ming-Hui Hung1,2,3, Chin-Chou Huang2,4,5,6
1Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan.
Insights
Cumulative blood pressure load (cBPL) significantly increases the risk of kidney function decline in hypertensive patients. Minimizing cBPL, particularly below 120 mmHg, is crucial for preventing hypertensive nephropathy and preserving renal health.
Area of Science:
- Nephrology
- Cardiology
- Hypertension Research
Background:
- Hypertension is a leading cause of chronic kidney disease.
- Assessing cumulative blood pressure load (cBPL) offers a novel metric for evaluating long-term BP exposure.
- Understanding the BP threshold for preventing hypertensive nephropathy is critical for patient management.
Purpose of the Study:
- To investigate the association between cumulative systolic blood pressure load (cSBL) and the risk of renal function decline.
- To identify the specific blood pressure (BP) thresholds that contribute to hypertensive nephropathy.
Main Methods:
- A single-center prospective cohort study involving 436 hypertensive patients.
- Cumulative blood pressure load (cBPL) calculated using ambulatory BP monitoring.
- Renal events defined by declines in estimated glomerular filtration rate (eGFR) >25% (minor) or >50% (major).
- Cox regression analysis employed to assess the relationship between cBPL and renal events.
Main Results:
- Over a mean follow-up of 5.1 years, 77 patients experienced >25% eGFR decline and 8 experienced >50% eGFR decline.
- cSBL at thresholds of 140, 130, and 120 mmHg were independently associated with minor renal events.
- cSBL at thresholds of 140, 130, and 120 mmHg were also independently associated with major renal events.
Conclusions:
- Cumulative blood pressure load is a significant predictor of renal function decline in hypertensive individuals.
- Maintaining a cSBL below 120 mmHg may be a key target for preventing hypertensive nephropathy.
- This study highlights the importance of continuous BP monitoring and load assessment in managing hypertensive kidney disease.
Abstract:
The study aims to assess the relationship between cumulative blood pressure load (cBPL) and the risk of renal function decline in hypertensive patients and determine the blood pressure (BP) threshold required to prevent hypertensive nephropathy. A single-center prospective cohort study was conducted on hypertensive patients. The cBPL was defined as the proportion of area beyond variable BP cutoffs under ambulatory BP monitoring. Renal events were defined as > 25% (minor) or > 50% (major) decline of baseline estimated glomerular filtration rate (eGFR). Cox regression analysis was conducted between cBPL, other ambulatory BP parameters, and renal events. The results revealed a total of 436 Han Chinese hypertensive patients were eligible for enrollment. During an average follow-up period of 5.1 ± 3.3 years, a decline of > 25% and > 50% in eGFR was observed in 77 and eight participants, respectively. Cox regression analysis revealed that cSBPL140 (hazard ratio [HR], 1.102; 95% confidence interval [CI], 1.017-1.193; p = .017), cSBPL130 (HR, 1.076; 95% CI, 1.019-1.137; p = .008), and cSBPL120 (HR, 1.054; 95% CI, 1.010-1.099; p = .015) were independently associated with minor renal events. Similarly, cSBPL140 (HR, 1.228; 95% CI, 1.037-1.455; p = .017), cSBPL130 (HR, 1.189; 95% CI, 1.045-1.354; p = .009), and cSBPL120 (HR, 1.155; 95% CI, 1.039-1.285; p = .008) were independently associated with major renal events. In conclusion, cBPL is associated with renal function decline in hypertensive patients. Minimizing cBPL120 may decrease the risk of hypertensive nephropathy.
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