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Cumulative hypertension burden and risk of end-stage renal disease

Hypertension Research volume 44, pages 1652–1661 (2021)Cite this article

Abstract

Hypertension is the leading risk factor for end-stage renal disease (ESRD). However, the association between sustained exposure to increased blood pressure (BP) and ESRD is not well established. This study investigated whether the cumulative hypertension burden is a substantial risk factor for ESRD. The incidence of ESRD among 2,144,801 participants identified from the Korean National Health Insurance Service database who had documented BP assessment data in their annual health check-up data from between 2006 and 2010, was determined. Over a median follow-up of 7.2 years, ESRD was identified in 1758 participants. Hypertension burden was defined as the cumulative exposure to hypertension (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg) during four consecutive follow-up periods and ranged from 0 to 4. The hypertension burden was as follows: 0 (n = 1,164,488), 77.6%; 1 (n = 292,377), 13.6%; 2 (n = 114,397), 5.3%; 3 (n = 52,671), 2.5%; and 4 (n = 20,886), 1.0%. Compared to the hypertension burden of 0, the adjusted hazard ratio for ESRD was 1.35, 1.54, 1.51, and 2.28 for hypertension burdens of 1, 2, 3, and 4, respectively. A positive dose-dependent relationship between hypertension burden and ESRD was found (P for interaction < 0.001). This association was maintained for sustained exposure to both systolic and diastolic hypertension burden. In conclusion, hypertension burden increases the risk of ESRD. Our study underlines the usefulness of a new assessment of the hypertension burden over a certain period for predicting the risk of ESRD in a large population-based cohort.

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Data availability

Anonymized data are publicly available from the National Health Insurance Sharing Service and can be accessed at https://nhiss.nhis.or.kr/bd/ab/bdaba000eng.do.

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Acknowledgements

This work was supported by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI18C0331, HR20C0021) and by a grant (BCRI20062, BCRI21023) from Chonnam National University Hospital Biomedical Research Institute.

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  1. These authors contributed equally: Kyung-Do Han, Soo Wan Kim

Authors and Affiliations

  1. Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea

    Chang Seong Kim, Hong Sang Choi, Eun Hui Bae, Seong Kwon Ma & Soo Wan Kim

  2. Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea

    Chang Seong Kim, Hong Sang Choi, Eun Hui Bae, Seong Kwon Ma & Soo Wan Kim

  3. Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea

    Bongseong Kim & Kyung-Do Han

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  1. Chang Seong Kim
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Contributions

CSK, KH, and SWK contributed to the study design. BK, HSC, EHB, SKM, and KH collected the data. CSK, BK, and KH performed the statistical analysis. CSK prepared the first draft of the paper. All the authors contributed intellectually to the revision of the article and approved the final version.

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Correspondence to Kyung-Do Han or Soo Wan Kim.

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Kim, C.S., Kim, B., Choi, H.S. et al. Cumulative hypertension burden and risk of end-stage renal disease. Hypertens Res 44, 1652–1661 (2021). https://doi.org/10.1038/s41440-021-00723-0

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