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논문분류	춘계학술대회 초록집
제목	Association between Systolic Blood Pressure and Incident Chronic Kidney Disease: A Nationwide Cohort Study
저자	Tae Ik Chang2, Cheol Ho Park1, Ea Wha Kang2, Jung Tak Jung Tak1, Tae-Hyun Yoo1, Shin-Wook Kang1, Seung Hyeok Han1
출판정보	2018; 2018(1):
키워드	systolic blood pressure \| chronic kidney disease \| marginal structural model
초록	Objectives: Recent studies favored lower blood pressure (BP) threshold to reduce cardiovascular risk. However, the optimal BP target is still under debate, given concerns about increased risk of chronic kidney disease (CKD) development if systolic BP (SBP) is too low. Methods: We studied the associations of baseline and time-updated SBP with incident CKD in a national cohort of 10.5 million adults with normal kidney function who participated in the National Health Insurance Service National Health Checkup Program between 2009 and 2015 using Cox proportional hazard models and marginal structural models (MSM), respectively. SBP levels were categorized into 5 groups by 10 mmHg increments and the 120-129 mmHg categories set as reference. CKD was defined as de novo development in estimated glomerular filtration rate (eGFR) of <60 mL/min per 1.73m2 for at least two consecutive measurements or a ≥30 % decline in eGFR from the baseline. Results: During 49,375,430 person-years of follow-up, a total of 289,293 (2.76%) new-onset CKD occurred. There was a graded linear association between SBP and incident CKD; the hazard ratios (95% confidence intervals [CIs]) among a priori selected categories (<110, 110-119, 130-139, and ≥140 mmHg) were 0.89 (0.88-0.90), 0.93 (0.92-0.94), 1.06 (1.05-1.07), and 1.23 (1.22-1.25) in baseline Cox models, and 0.76 (0.75-0.77), 0.89 (0.88-0.90), 1.21 (1.20-1.22), and 1.59 (1.57-1.61) in MSM, respectively. These linear relationships were largely consistent across various subgroups. Notably, in subgroups with antihypertensive medications, SBP of <110 mmHg was also associated with higher risk for CKD development (HR 1.06, 95% CI 1.00-1.12 in MSM). Conclusions: In a large national cohort of Korea, SBP levels were linearly associated with the risk of incident CKD. However, SBP of <110 mmHg during antihypertensive therapy was also associated with increased risk for CKD, suggesting that caution should be taken in the use of BP lowering treatment to prevent adverse renal outcomes.
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