title: Ethnic differences in the association between blood pressure components and chronic kidney disease in middle aged and older Asian adults.
abstract: BACKGROUND
  Chronic kidney disease (CKD) is an emerging public health problem worldwide. Previous studies have shown an association between blood pressure (BP) and CKD. However, it is not clear if there are ethnic differences in this association. We examined the association between BP and CKD in a multi-ethnic Asian population in Singapore.
  
  
  METHODS
  We analysed data from three large population-based studies conducted between 2004-2011, (n=3,167 Chinese, 3,082 Malays and 3,228 Indians) aged 40-80 years. CKD was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m² from serum creatinine. Hypertension was defined as a self-reported current use of antihypertensive medication or systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg. We also analysed the association of CKD with individual BP components.
  
  
  RESULTS
  The prevalence of both hypertension and CKD was higher among Malays (68.6, 21%) compared to Chinese (57.9, 5.9%) and Indians (56.0, 7.4%), but treatment for hypertension was lower among Malays (53.4%) compared to Chinese (89.8%) and Indians (83.1%). Hypertension was associated with CKD in all three ethnic groups (OR [95% CI] = 2.71 [1.59-4.63], 2.08 [1.62-2.68], 2.43 [1.66-3.57] in Chinese, Malays and Indians). Among the BP components, both systolic and diastolic BP were associated with CKD in Malays whereas, systolic BP was not significantly associated with CKD, and diastolic BP showed an inverse association which was explained by anti-hypertensive medication use in Chinese and Indians.
  
  
  CONCLUSIONS
  Hypertension was associated with CKD in Chinese, Malays and Indians. However, the BP components were associated with CKD only in Malays.
authors.affiliation: Singapore Eye Research Institute, 11 Third Hospital Avenue #06-13, SNEC Bldg, Singapore, Singapore. charumathi.sabanayagam@seri.com.sg
authors.forename: Charumathi
authors.initials: C
authors.lastname: Sabanayagam
authors.forename: Boon Wee
authors.initials: BW
authors.lastname: Teo
authors.forename: E Shyong
authors.initials: ES
authors.lastname: Tai
authors.forename: Tazeen H
authors.initials: TH
authors.lastname: Jafar
authors.forename: Tien Yin
authors.initials: TY
authors.lastname: Wong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People / Q000208:ethnology*; D001794:Blood Pressure / Q000502:physiology*; D005006:Ethnicity / Q000208:ethnology; D005260:Female; D006801:Humans; D007194:India / Q000208:ethnology; D008296:Malaysia / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis* / Q000208:ethnology* / Q000503:physiopathology