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Abstract
It is well-known that hypertension exacerbates chronic kidney disease (CKD) progression, however, the optimal target blood pressure (BP) level in patients with CKD remains unclear. This study aimed to assess the optimal BP level for preventing CKD progression. The risk of renal outcome among different BP categories at baseline as well as 1 year after, were evaluated using individual CKD patient data aged between 40 and 74 years from FROM-J [Frontier of Renal Outcome Modifications in Japan] study. The renal outcome was defined as ≥ 40% reduction in estimated glomerular filtration rate to < 60 mL/min/1.73 m2, or a diagnosis of end stage renal disease. Regarding baseline BP, the group of systolic BP (SBP) 120–129 mmHg had the lowest risk of the renal outcome, which increased more than 60% in SBP ≥ 130 mmHg group. A significant increase in the renal outcome was found only in the group of diastolic BP ≥ 90 mmHg. The group of BP < 130/80 mmHg had a benefit for lowering the risk regardless of the presence of proteinuria, and it significantly reduced the risk in patients with proteinuria. Achieving SBP level < 130 mmHg after one year resulted in a 42% risk reduction in patients with SBP level ≥ 130 mmHg at baseline. Targeting SBP level < 130 mmHg would be associated with the preferable renal outcome.
Clinical Trial Registration-URL: https://www.umin.ac.jp/ctr/. Unique identifier: UMIN000001159 (16/05/2008).
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1 Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama, Japan (GRID:grid.261356.5) (ISNI:0000 0001 1302 4472)
2 Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama, Japan (GRID:grid.261356.5) (ISNI:0000 0001 1302 4472); Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Department of Chronic Kidney Disease and Cardiovascular Disease, Dentistry, and Pharmaceutical Science, Okayama, Japan (GRID:grid.261356.5) (ISNI:0000 0001 1302 4472); Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Department of Medicine and Clinical Science, Okayama, Japan (GRID:grid.261356.5) (ISNI:0000 0001 1302 4472)
3 Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Department of Gastroenterological Surgery Transplant and Surgical Oncology, Okayama, Japan (GRID:grid.261356.5) (ISNI:0000 0001 1302 4472)
4 Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama, Japan (GRID:grid.261356.5) (ISNI:0000 0001 1302 4472); University of Hyogo, Hyogo, Japan (GRID:grid.266453.0) (ISNI:0000 0001 0724 9317)
5 University of Tsukuba, Department of Nephrology, Faculty of Medicine, Tsukuba, Japan (GRID:grid.20515.33) (ISNI:0000 0001 2369 4728)
6 Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama, Japan (GRID:grid.261356.5) (ISNI:0000 0001 1302 4472); Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Department of Human Resource Development of Dialysis Therapy for Kidney Disease, Okayama, Japan (GRID:grid.261356.5) (ISNI:0000 0001 1302 4472)
7 Niigata University Graduate School of Medical and Dental Science, Division of Clinical Nephrology and Rheumatology, Niigata, Japan (GRID:grid.260975.f) (ISNI:0000 0001 0671 5144)
8 Tokyo-Kita Medical Center, Tokyo, Japan (GRID:grid.440146.3)
9 Nagoya University, Nagoya, Japan (GRID:grid.27476.30) (ISNI:0000 0001 0943 978X)
10 Okayama University, Okayama, Japan (GRID:grid.261356.5) (ISNI:0000 0001 1302 4472)
11 Yaizu City Hospital, Shizuoka, Japan (GRID:grid.261356.5)