Epidemiology and Health

Original Article

Effect of long-term blood pressure trajectory on the future development of chronic kidney disease: an analysis of data from the Korean National Insurance Health Checkup Study: Wonmook Hwang, Eu Jin Lee, Jae-Hyeong Park, Soon-Ki Ahn; Epidemiol Health. 2024;46:e2024090. Published online November 19, 2024; DOI: https://doi.org/10.4178/epih.e2024090

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Chronic kidney disease (CKD) is a prevalent health issue that causes the irreversible loss of functioning nephrons, end-stage renal disease, cardiovascular disease, and premature mortality. Hypertension is the leading cause of CKD. However, the effect of long-term blood pressure (BP) changes on the development of CKD is still unknown. Therefore, the current study investigated the association between BP trajectory and the future development of CKD.
METHODS
In this study, 246,874 individuals aged ≥40 years who underwent health examinations during the screening period (2002-2009) were evaluated. The systolic blood pressure (SBP) trajectory was determined using latent-class mixture modeling. New-onset CKD was identified during the follow-up period (2010-2019). The association between SBP trajectories and new-onset CKD was assessed.
RESULTS
In total, 111,900 adults (53,420 females, 51.9±6.4 years old) presented with 2 SBP trajectory classes: class 1 (n=66,935) and class 2 (n=44,965). During the follow-up period, patients with SBP trajectory class 2 had an approximately 2.1-fold increased risk of developing CKD (unadjusted hazard ratio [HR], 2.11; 95% confidence interval [CI], 1.99 to 2.25; p<0.001). In the multivariate analysis adjusted for other significant variables, SBP trajectory class 2 was significantly associated with CKD in males (HR, 1.09; 95% CI, 1.00 to 1.19; p=0.037), but not in females (HR, 1.06; 95% CI, 0.95 to 1.18; p=0.321).
CONCLUSIONS
An elevated longitudinal BP was associated with a higher incidence of CKD in male participants aged ≥40 years. Nevertheless, further studies are needed to validate the clinical significance of an elevated SBP trajectory on CKD development.; Summary

Korean summary
궤적분석으로 평가한 수축기 혈압의 지속적 상승은 40세 이상의 남성 피험자에서 만성 신장 질환 발생률 증가와 관련이 있었다.

Key Message
Elevated longitudinal systolic blood pressure, as determined by trajectory, was found to be associated with an increased risk of developing chronic kidney disease in male subjects over the age of 40.

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