title: Pre-hypertension as a significant predictor of chronic kidney disease in a general population: the Ohasama Study.
abstract: BACKGROUND
  Hypertension is associated with an increased risk of development of chronic kidney disease (CKD). However, it is unclear whether pre-hypertension is related to the incidence of CKD.
  
  
  METHODS
  The incidence of CKD defined as positive proteinuria or estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m(2) was examined in 2150 inhabitants without pre-existing CKD from the general Japanese population. The association of blood pressure and CKD incidence was examined using a Cox regression model adjusted for age, sex, habitual smoking and drinking, obesity, history of cardiovascular disease, diabetes mellitus or hypercholesterolemia, eGFR at baseline, number of follow-up examinations and year of baseline examination. Participants were categorized according to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure.
  
  
  RESULTS
  Participants were categorized into normotension (n = 586, 27.3 % ), pre-hypertension (n = 815, 37.9 % ), Stage 1 hypertension (n = 386, 18.0 % ) and Stage 2 hypertension (n = 363, 16.9 % ). During a mean follow-up of 6.5 years (14 023 person-years), 461 incidences of CKD were recorded. Compared to normotension, adjusted hazard ratios of CKD were significantly higher for pre-hypertension (1.49, P < 0.003), Stage 1 (1.83, P < 0.001) and Stage 2 (2.55, P < 0.001) hypertension. The population-attributable fraction of pre-hypertension (12.1 % ) was considered to be compatible to that of Stage 1 (8.6 % ) and Stage 2 (14.9 % ) hypertension.
  
  
  CONCLUSIONS
  This was the first study to demonstrate that pre-hypertension was significantly associated with an increased risk of CKD and was one of the considerable causes of CKD in the general population.
authors.affiliation: Department of Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Medicine and PharmaceuticalSciences, Sendai, Japan.
authors.forename: Atsuhiro
authors.initials: A
authors.lastname: Kanno
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kikuya
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Ohkubo
authors.forename: Takanao
authors.initials: T
authors.lastname: Hashimoto
authors.forename: Michihiro
authors.initials: M
authors.lastname: Satoh
authors.forename: Takuo
authors.initials: T
authors.lastname: Hirose
authors.forename: Taku
authors.initials: T
authors.lastname: Obara
authors.forename: Hirohito
authors.initials: H
authors.lastname: Metoki
authors.forename: Ryusuke
authors.initials: R
authors.lastname: Inoue
authors.forename: Kei
authors.initials: K
authors.lastname: Asayama
authors.forename: Yoh
authors.initials: Y
authors.lastname: Shishido
authors.forename: Haruhisa
authors.initials: H
authors.lastname: Hoshi
authors.forename: Masaaki
authors.initials: M
authors.lastname: Nakayama
authors.forename: Kazuhito
authors.initials: K
authors.lastname: Totsune
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Satoh
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sato
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Imai
mesh_terms: D000368:Aged; D001794:Blood Pressure; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D058246:Prehypertension / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology; D012307:Risk Factors