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Pulse pressure modifies the association between diastolic blood pressure and decrease in kidney function: the Japan

Hiroyuki Tamaki1, Masahiro Eriguchi1, Hisako Yoshida2

  • 1Department of Nephrology, Nara Medical University, Kashihara, Nara, Japan.

Clinical Kidney Journal
|June 7, 2024
PubMed

Insights

Diastolic blood pressure (DBP) impacts kidney function differently based on pulse pressure (PP). In high PP individuals, low DBP is linked to increased kidney outcomes, unlike in normal or low PP groups.

Area of Science:

  • Nephrology
  • Cardiology
  • Epidemiology

Background:

  • The prognostic value of diastolic blood pressure (DBP) for kidney function remains unclear, unlike systolic blood pressure (SBP).
  • Pulse pressure (PP), a marker of arteriosclerosis, may influence the relationship between DBP and kidney outcomes.

Purpose of the Study:

  • To investigate the association between DBP and kidney outcomes across different levels of PP.
  • To determine if PP modifies the prognostic value of DBP for kidney function.

Main Methods:

  • A longitudinal study of 725,022 participants from the Japan Specific Health Checkups Study (2008-2014).
  • Participants were stratified into low (≤39 mmHg), normal (40-59 mmHg), and high (≥60 mmHg) PP subgroups.
  • Cox proportional hazards models examined the association between SBP/DBP and kidney outcomes (30% eGFR decline).

Main Results:

  • Higher SBP was consistently associated with increased kidney outcomes across all PP subgroups.
  • DBP showed a positive linear association with kidney outcomes in low and normal PP subgroups.
  • In the high PP subgroup, both low (≤60 mmHg) and high (≥101 mmHg) DBP were associated with higher kidney outcome incidence (U-shaped curve).

Conclusions:

  • Diastolic blood pressure's association with kidney outcomes varies significantly with pulse pressure levels.
  • Lower DBP is a risk factor for kidney outcomes specifically in individuals with high pulse pressure.
  • These findings highlight the importance of considering PP when assessing DBP's risk for kidney disease progression.
Abstract

Keywords:
diastolic blood pressurekidney diseasepulse pressuresystolic blood pressure

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