Blood Pressure and End-Stage Renal Disease in Men

doi:10.1056/NEJM199601043340103

Volume 334:13-18		January 4, 1996		Number 1

Blood Pressure and End-Stage Renal Disease in Men

Michael J. Klag, M.D., M.P.H., Paul K. Whelton, M.D., Bryan L. Randall, M.S., James D. Neaton, Ph.D., Frederick L. Brancati, M.D., M.H.S., Charles E. Ford, Ph.D., Neil B. Shulman, M.D., and Jeremiah Stamler, M.D.

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ABSTRACT

Background End-stage renal disease in the United States createsa large burden for both individuals and society as a whole.Efforts to prevent the condition require an understanding ofmodifiable risk factors.

Methods We assessed the development of end-stage renal diseasethrough 1990 in 332,544 men, 35 to 57 years of age, who werescreened between 1973 and 1975 for entry into the Multiple RiskFactor Intervention Trial (MRFIT). We used data from the nationalregistry for treated end-stage renal disease of the Health CareFinancing Administration and from records on death from renaldisease from the National Death Index and the Social SecurityAdministration.

Results During an average of 16 years of follow-up, 814 subjectseither died of end-stage renal disease or were treated for thatcondition (15.6 cases per 100,000 person-years of observation).A strong, graded relation between both systolic and diastolicblood pressure and end-stage renal disease was identified, independentof associations between the disease and age, race, income, useof medication for diabetes mellitus, history of myocardial infarction,serum cholesterol concentration, and cigarette smoking. As comparedwith men with an optimal level of blood pressure (systolic pressure<120 mm Hg and diastolic pressure <80 mm Hg), the relativerisk of end-stage renal disease for those with stage 4 hypertension(systolic pressure >210 mm Hg or diastolic pressure >120mm Hg) was 22.1 (P<0.001). These relations were not due toend-stage renal disease that occurred soon after screening and,in the 12,866 screened men who entered the MRFIT study, werenot changed by taking into account the base-line serum creatinineconcentration and urinary protein excretion. The estimated riskof end-stage renal disease associated with elevations of systolicpressure was greater than that linked with elevations of diastolicpressure when both variables were considered together.

Conclusions Elevations of blood pressure are a strong independentrisk factor for end-stage renal disease; interventions to preventthe disease need to emphasize the prevention and control ofboth high-normal and high blood pressure.

Source Information

From the Departments of Medicine and Epidemiology (M.J.K., P.K.W., F.L.B.) and the Department of Health Policy and Management (M.J.K.), Johns Hopkins University School of Medicine and Johns Hopkins University School of Hygiene and Public Health, Baltimore; the Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis (B.L.R., J.D.N.); the University of Texas Health Science Center at Houston, Houston (C.E.F.); the Department of Medicine, Emory University, Atlanta (N.B.S.); and the Department of Preventive Medicine, Northwestern University Medical School, Chicago (J.S.).

Address reprint requests to Dr. Klag at the Welch Center for Prevention, Epidemiology, and Clinical Research, 2024 E. Monument St., Suite 2-600, Baltimore, MD 21205-2223.

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Douglas, J. G., Bakris, G. L., Epstein, M., Ferdinand, K. C., Ferrario, C., Flack, J. M., Jamerson, K. A., Jones, W. E., Haywood, J., Maxey, R., Ofili, E. O., Saunders, E., Schiffrin, E. L., Sica, D. A., Sowers, J. R., Vidt, D. G., the Hypertension in African Americans Working Grou, (2003). Management of High Blood Pressure in African Americans: Consensus Statement of the Hypertension in African Americans Working Group of the International Society on Hypertension in Blacks. Arch Intern Med 163: 525-541 [Full Text]
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de Jong, P. E., Hillege, H. L., Pinto-Sietsma, S. J., de Zeeuw, D. (2003). Screening for microalbuminuria in the general population: a tool to detect subjects at risk for progressive renal failure in an early phase?. Nephrol Dial Transplant 18: 10-13 [Full Text]
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Wright, J. T. Jr, Bakris, G., Greene, T., Agodoa, L. Y., Appel, L. J., Charleston, J., Cheek, D., Douglas-Baltimore, J. G., Gassman, J., Glassock, R., Hebert, L., Jamerson, K., Lewis, J., Phillips, R. A., Toto, R. D., Middleton, J. P., Rostand, S. G., for the African American Study of Kidney Disease a, (2002). Effect of Blood Pressure Lowering and Antihypertensive Drug Class on Progression of Hypertensive Kidney Disease: Results From the AASK Trial. JAMA 288: 2421-2431 [Abstract] [Full Text]
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