Combined effects of blood pressure and glucose status on the risk of chronic kidney disease.

2024.04.26.

Toyama, M., Satoh, M., Nakayama, S. et al. Combined effects of blood pressure and glucose status on the risk of chronic kidney disease. Hypertens Res (2024). https://doi.org/10.1038/s41440-024-01683-x

　若年および中年成人における慢性腎臓病（CKD）罹患に対する血圧と血糖の複合効果を評価した。ベースライン時にCKDの既往のない60歳未満の日本人1,297,341人（男性60.1％；平均年齢41.4±9.3歳）を、共変量を用いた区間打ち切りCox比例ハザードモデルを用い検討したところ、中央値2.1年の追跡期間中に、80,187人の参加者にCKDの新規罹患がみられた。
　降圧治療（AHT）を受けていない参加者において、CKD発症に対する収縮期血圧15mmHg上昇あたりの補正ハザード比（95％信頼区間）は、正常血糖群、境界域血糖群、糖尿病群でそれぞれ1.08（1.07-1.09）、1.12（1.10-1.13）、1.15（1.12-1.18）と正常血糖群と比較して境界型血糖群および糖尿病群で有意に高かった。血圧と境界型血糖値との間の交互作用は、アウトカムの定義を蛋白尿に限定した場合に明らかであった。厳格な血圧管理は、若年・中年層における血糖値の悪い人のCKDの早期予防に重要な役割を果たすかもしれない。

This study aimed to assess the combined effects of blood pressure (BP) and glucose status on chronic kidney disease (CKD) incidence in young and middle-aged adults. We examined data from 1,297,341 Japanese individuals aged <60 years (60.1% men; mean age 41.4 ± 9.3 years) with no history of CKD at baseline. The interval-censored Cox proportional hazards model with covariates was used. During a median follow-up period of 2.1 years, new onset CKD (estimated glomerular filtration rate <60 ml/min/1.73 m2 and/or proteinuria) occurred in 80,187 participants. In participants without antihypertensive treatment (AHT), the adjusted hazard ratios (95% confidence interval) per 1-standard deviation, that is, 15 mmHg increase in systolic BP for CKD incidence, were 1.08 (1.07–1.09), 1.12 (1.10–1.13), and 1.15 (1.12–1.18) in normoglycemia, borderline glycemia, and diabetes groups, respectively. These ratios were significantly higher in the borderline glycemia and diabetes groups compared with those in the normoglycemia group (interaction p < 0.0001). The interaction between BP and borderline glycemia was evident when the outcome definition was restricted to proteinuria. In participants under AHT, systolic BP was most strongly associated with CKD risk in the diabetes group, although no significant interaction was observed. High BP and high glucose status may synergistically increase the incidence of CKD. Strict BP management may play an important role in the early prevention of CKD in individuals with worse glucose status within the young and middle-aged population.

The impact of clinical inertia on uncontrolled blood pressure in treated hypertension: real-world, longitudinal data from Japan

Satoh M, Muroya T, Murakami T, Obara T, Asayama K, Ohkubo T, Imai Y, Metoki H.

We aimed to quantify the impact of inadequate pharmacological therapy on uncontrolled blood pressure (BP) using Japanese real-world data. This retrospective cohort study used databases provided by DeSC Healthcare, Inc (Tokyo, Japan). We identified 27,652 patients with hypertension (age, 60.7 ± 9.1 years; men, 56.4%) who were not receiving antihypertensive treatment at the initial visit (pre-treatment) and were under treatment at the next visit (post-treatment). Patients were classified into the following groups by the number of antihypertensive drug classes and defined daily dose (DDD): one antihypertensive drug class with a low dose (DDD < 1.0), one antihypertensive drug class with a moderate-to-high dose (DDD ≥ 1.0), two antihypertensive drug classes with a low dose (DDD < 2.0), two antihypertensive drug classes with a moderate-to-high dose (DDD ≥ 2.0), and ≥three antihypertensive drug classes. The pre-treatment systolic/diastolic BP was 157.7 ± 15.4/94.2 ± 11.5 mmHg. Overall, 43.0% of patients had uncontrolled BP (post-treatment BP ≥ 140/ ≥ 90 mmHg). High pre-treatment BP was a strong factor for uncontrolled BP. After adjustments for covariates, including the pre-treatment mean BP, the proportion of patients with uncontrolled BP was 2.08 times higher in the one antihypertensive drug class with a low dose group than in the ≥three antihypertensive drug classes group. The preventable fraction due to <three antihypertensive drug classes for uncontrolled BP was 40.6%. Only 9.9% of patients with the pre-treatment BP ≥ 180/ ≥ 110 mmHg were prescribed ≥ three antihypertensive drug classes. High pre-treatment BP and inadequate antihypertensive treatment were major factors contributing to uncontrolled BP. Adequate treatment intensification would resolve approximately 40% of uncontrolled BP cases among Japanese patients treated for hypertension.

Keywords: Blood pressure; Clinical inertia; Cohort study; Epidemiology.

A Combination of Blood Pressure and Total Cholesterol Increases the Lifetime Risk of Coronary Heart Disease Mortality: EPOCH-JAPAN.

2020.4.8.

Lifetime risk (LTR) indicates the absolute risk of disease during the remainder of an individual’s lifetime. We aimed to assess the LTRs for coronary heart disease (CHD) mortality associated with blood pressure (BP) and total cholesterol levels in an Asian population using a meta-analysis of individual participant data because no previous studies have assessed this risk.

We analyzed data from 105,432 Japanese participants in 13 cohorts. Apart from grade 1 and 2-3 hypertension groups, we defined “normal BP” as systolic/diastolic BP ＜130/＜80 mmHg and “high BP” as 130-139/80-89 mmHg. The sex-specific LTR was estimated while considering the competing risk of death.

During the mean follow-up period of 15 years (1,553,735 person-years), 889 CHD deaths were recorded. The 10-year risk of CHD mortality at index age 35 years was ≤ 0.11%, but the corresponding LTR was ≥ 1.84%. The LTR of CHD at index age 35 years steeply increased with an increase in BP of participants with high total cholesterol levels [≥ 5.7 mmol/L (220 mg/dL)]. This risk was 7.73%/5.77% (95% confidence interval: 3.53%-10.28%/3.83%-7.25%) in men/women with grade 2-3 hypertension and high total cholesterol levels. In normal and high BP groups, the absolute differences in LTRs between the low and high total cholesterol groups were ≤ 0.25% in men and ≤ 0.40% in women.

High total cholesterol levels contributed to an elevated LTR of CHD mortality in hypertensive individuals. These findings could help guide high-risk young individuals toward initiating lifestyle changes or treatments.

Satoh M, Ohkubo T, Asayama K, Murakami Y, Sugiyama D, Waki T, Tanaka-Mizuno S, Yamada M, Saitoh S, Sakata K, Irie F, Sairenchi T, Ishikawa S, Kiyama M, Okayama A, Miura K, Imai Y, Ueshima H, Okamura T; Evidence for Cardiovascular Prevention from Observational Cohorts in Japan (EPOCH–JAPAN) Research Group. J Atheroscler Thromb. 2020 Apr 8. doi: 10.5551/jat.52613. Online ahead of print. PMID: 32269207