Associations of Long-Term Blood Pressure Burden and Variability With Kidney Function Decline

Long-term blood pressure (BP) burden and visit-to-visit BP variability may better capture cumulative hemodynamic stress on the kidneys than single-visit BP measurements, yet evidence linking these metrics with kidney function decline in the general population remains limited. We analyzed 2,821 adults with preserved kidney function from a prospective cohort study. Cumulative BP exposure and visit-to-visit BP variability were derived from BP measurements obtained at baseline and two follow-up visits. Outcomes included annual estimated glomerular filtration rate (eGFR) slope and study-defined incident chronic kidney disease (CKD). Higher long-term BP exposure, particularly systolic BP (SBP), and greater BP variability were associated with faster kidney function decline. A 1-standard deviation increase in cumulative SBP was associated with a more negative annual eGFR slope (β≈-0.15 to -0.18 mL/min/1.73 m² per year). Cumulative SBP was also independently associated with study-defined incident CKD (hazard ratio 1.45; 95% confidence interval 1.15-1.83), whereas associations for diastolic BP and BP variability were generally weaker. No evidence of nonlinearity or significant effect modification was observed. These findings suggest that long-term BP burden, particularly cumulative SBP, is associated with accelerated kidney function decline in the general population.