Optimal blood pressure for the prevention of hypertensive nephropathy in nondiabetic hypertensive patients in Taiwan

Abstract

Hypertension is a global health burden. However, clinical reference for the adequate management of blood pressure (BP) to prevent renal injury has yet to be established. Thus, this study aimed to investigate whether optimal control and maintenance of BP at < 140/90, < 130/80, or < 120/70 mmHg could prevent hypertensive nephropathy in nondiabetic hypertensive patients. A single‐center observational study of 351 nondiabetic hypertensive patients was conducted in Taiwan. The average age of the participants was 64.0 years, and approximately 57.8% of the participants were men. Kidney function was assessed using estimated glomerular filtration rate (eGFR). The baseline eGFR was 83.8 ± 19.8 mL/min/1.73 m2. All patients were followed up every 3 months and underwent office BP measurement and blood sampling. Renal events were defined as> 25% and> 50% decline in eGFR. During an average follow‐up period of 4.2 ± 2.3 years, a> 25% and> 50% decline in eGFR was noted in 49 and 11 patients, respectively. The Cox regression analysis revealed that a baseline BP ≥ 140/90 mmHg (hazard ratio [HR]: 1.965; 95% confidence interval [CI]: 1.099–3.514, P = 0.023) and ≥ 130/80 mmHg (HR: 2.799; 95% CI: 1.286–6.004, P = 0.009) increased the risk of> 25% decline in eGFR. Moreover, a baseline BP ≥ 140/90 mmHg (HR: 8.120; 95% CI: 1.650–39.956, P = 0.010) and follow‐up BP ≥ 140/90 mmHg (HR: 6.402; 95% CI: 1.338–30.637, P = 0.020) increased the risk of> 50% decline in eGFR. In conclusion, a stringent baseline BP < 130/80 mmHg and a follow‐up BP < 140/90 mmHg can be considered optimal cutoff values for clinical practice to prevent hypertensive nephropathy.

Uric Acid and Impairment of Renal Function in Non-diabetic Hypertensive Patients

“…In some hypertensive patients, however, renal function continued to deteriorate progressively even when the BP was under control. In our previous study, 11.2% of hypertensive patients still suffered from renal function decline when their BP was controlled to <140/90 mmHg ( 17 ). It is essential to identify specific characteristics that increase the risk of renal insufficiency in this population.…”

“…Renal events during the follow-up period were defined as >25% decline or >50% decline in eGFR, which has been used to indicate minor or major renal dysfunction in previous studies ( 16 , 17 ).…”

SLC12A3 Variation and Renal Function in Chinese Patients With Hypertension

“…The inclusion criteria were as follows: age ≥ 20 years; essential hypertensive patients; no medical history of severe diseases; and no acute disease in the 2 weeks prior to the study. Participants with secondary hypertension were excluded from the study ( 20 ). Only participants without diabetes mellitus were included in the present study.…”

“…The participants in cohort 3 were followed up to assess renal function decline. Renal events during the follow-up period were defined as minor nephropathy, >25% decline in eGFR, and major nephropathy, >50% decline in eGFR; these definitions have been used previously ( 20 , 22 ).…”

Blood pressure management and renal protection: Revisiting hypertensive nephropathy

“…Studies which solely enrolled otherwise healthy individuals to investigate the impact of BP on renal function are scarce. Our previous study enrolled 351 nondiabetic patients with fair renal function and proposed an optimal office BP cutoff at 140/90 mmHg on the initial encounter and 130/80 mmHg for subsequent maintenance, 34 which significantly reduced major and minor renal events, that is, 50% and 25% eGFR decline from baseline, respectively. For patients with baseline renal insufficiency, the goal of BP control remains elusive.…”