Association Between Hypertension and Kidney Function Decline: The Atherosclerosis Risk in Communities (ARIC) Study

Abstract

Rationale & objective: The relationship between hypertension, antihypertension medication use, and change in glomerular filtration rate (GFR) over time among individuals with preserved GFR requires investigation.

Study design: Observational study.

Setting & participants: 14,854 participants from the Atherosclerosis Risk in Communities (ARIC) Study.

Predictors: Baseline hypertension status (1987-1989) was categorized according to the 2017 American College of Cardiology/American Heart Association Clinical Practice Guideline as normal blood pressure, elevated blood pressure, stage 1 hypertension, stage 2 hypertension without medication, or stage 2 hypertension with medication.

Outcomes: Slope of estimated GFR (eGFR) at 5 study visits over 30 years.

Analytical approach: Mixed models with random intercepts and random slopes were fit to evaluate the association between baseline hypertension status and slope of eGFR.

Results: At baseline, 13.2%, 7.3%, and 19.4% of whites and 15.8%, 14.9%, and 39.9% of African Americans had stage 1 hypertension, stage 2 hypertension without medication, and stage 2 hypertension with medication. Compared with those with normal blood pressure, the annual eGFR decline was greater in people with higher blood pressure (whites: elevated blood pressure, -0.11mL/min/1.73m²; stage 1 hypertension, -0.15mL/min/1.73m²; stage 2 hypertension without medication, -0.36mL/min/1.73m²; stage 2 hypertension with medication, -0.17mL/min/1.73m²; African Americans: elevated blood pressure, -0.21mL/min/1.73m²; stage 1 hypertension, -0.16mL/min/1.73m²; stage 2 hypertension without medication, -0.50mL/min/1.73m²; stage 2 hypertension with medication, -0.16mL/min/1.73m²). The 30-year predicted probabilities of developing chronic kidney disease stage G3a+with normal blood pressure, elevated blood pressure, stage 1 hypertension, stage 2 hypertension without medication, or stage 2 hypertension with medication among whites were 54.4%, 61.6%, 64.7%, 78.1%, and 70.9%, respectively, and 55.4%, 62.8%, 60.9%, 76.1%, and 66.6% among African Americans.

Limitations: Slope estimated using a maximum of 5 eGFR assessments; differential loss to follow-up.

Conclusions: Compared to normotension, baseline hypertension status was associated with faster kidney function decline over 30-year follow-up in a general population cohort. This difference was attenuated among people using antihypertensive medications.

Keywords: African Americans; CKD risk; Hypertension; blood pressure; chronic kidney disease (CKD); disease projection; estimated glomerular filtration rate (eGFR); kidney function; race; racial differences; trajectory.