Pulse pressure modifies the association between diastolic blood pressure and decrease in kidney function: The Japan Specific Health Checkups (J SHC) Study

BackgroundUnlike systolic blood pressure (SBP), the prognostic value of diastolic blood pressure (DBP) in kidney function has not been established. We hypothesized that pulse pressure (PP), which is associated with arteriosclerosis, would affect the prognostic value of DBP. MethodsThis longitudinal study used data from the Japan Specific Health Checkups Study conducted between 2008 and 2014. The participants were stratified into 3 PP subgroups (low-PP [≤]39, normal-PP 40-59, and high-PP [≥]60 mmHg). The exposures of interest were SBP and DBP, and the association between SBP/DBP and kidney outcomes (30% decline in the estimated glomerular filtration rate from baseline) was examined in each PP subgroup using a Cox proportional hazards model. ResultsAmong 725,022 participants, 20,414 (2.8%) developed kidney outcomes during a median follow-up period of 34.6 months. Higher SBP was consistently associated with a higher incidence of kidney outcome in all PP subgroups. Although DBP had a positive linear association with the incidence of kidney outcome in low-and normal-PP subgroups, both lower ([≤]60 mmHg) and higher ([≥]101 mmHg) DBP were associated with a higher incidence of kidney outcome in high-PP subgroup with U-shaped curve. Hazard ratios (95% confidence intervals) of [≤]60 mmHg (reference: 61-80 mmHg in normal-PP subgroup) and [≥]101 mmHg were 1.26 (1.15-1.38) and 1.86 (1.62-2.14), respectively. ConclusionIn this large population-based cohort, DBP was differently associated with kidney outcome by PP levels; lower DBP was significantly associated with a higher incidence of kidney outcome in high-PP subgroup but not in low-and normal-PP subgroups.