Blood Pressure Phenotypes and Cardio-Kidney Outcomes: Findings From UK Biobank Data

Hypertension is a leading cause of cardio-kidney outcomes (CKO). However, distinct blood pressure (BP) phenotypes and their effect on CKO remain underexplored. This study aimed to evaluate the independent contributions of BP phenotypes to CKO.

This prospective, population-based study included UK Biobank participants enrolled between 2006 and 2010 with baseline systolic BP ≥90 mm Hg and estimated glomerular filtration rate ≥60 mL/min per 1.73 m², excluding those with prior chronic kidney disease and cardiovascular disease. Five BP phenotypes were constructed based on the 2017 American Heart Association hypertension criteria (≥130/80 mm Hg): normotension, systolic-diastolic hypertension, isolated systolic hypertension, isolated diastolic hypertension, and isolated low diastolic BP. The primary outcome was CKO, a composite of incident chronic kidney disease, 3-point major cardiovascular events, and all-cause mortality based on the International Classification of Diseases and Office of Population Censuses and Surveys Classification of Interventions and Procedures, Version 4, codes. Associations between BP phenotypes and CKO were evaluated using multivariable Cox proportional hazards models adjusted for demographic, lifestyle, and clinical covariates.

Among 322 218 participants (mean age, 55.8±8.1 years; 42.5% men), 61 918 (19.2%) had normotension, 159 853 (49.6%) had systolic-diastolic hypertension, 43 939 (13.6%) had isolated systolic hypertension, 28 169 (8.7%) had isolated diastolic hypertension, and 28 339 (8.8%) had isolated low diastolic BP. Over a median follow-up of 13.6 years, 32 440 CKO events occurred. All BP phenotypes were associated with an increased CKO risk compared with normotension: isolated systolic hypertension (hazard ratio, 1.22 [95% CI, 1.17-1.27]), systolic-diastolic hypertension (hazard ratio, 1.21 [95% CI, 1.16-1.25]), isolated diastolic hypertension (hazard ratio, 1.11 [95% CI, 1.05-1.17]), and isolated low diastolic BP (hazard ratio, 1.10 [95% CI, 1.05-1.17]).

Distinct BP phenotypes beyond absolute BP thresholds confer differential risks for CKO. Interventional studies are needed to evaluate strategies targeting combined systolic-diastolic phenotypes to reduce CKO risk.