Prehypertension and Incidence of ESRD: a systematic review and meta-analysis.
BACKGROUND
Studies of the association of prehypertension with the incidence of end-stage renal disease (ESRD) after adjusting for other cardiovascular risk factors have shown controversial results.


METHODS
Systematic review and meta-analysis of prospective cohort studies.


METHODS
Adults with prehypertension.


METHODS
Studies evaluating the association of prehypertension with the incidence of ESRD identified by searches in PubMed, EMBASE, and Cochrane Library databases and conference proceedings, without language restriction.


METHODS
Prehypertension.


RESULTS
The relative risks (RRs) of ESRD were calculated and reported with 95% CIs. Subgroup analyses were conducted according to blood pressure (BP), age, sex, ethnicity, and study characteristics.


RESULTS
Data from 1,003,793 participants were derived from 6 prospective cohort studies. Compared with optimal BP, prehypertension significantly increased the risk of ESRD (RR, 1.59; 95% CI, 1.39-1.91). In subgroup analyses, prehypertension significantly predicted higher ESRD risk across age, sex, ethnicity, and study characteristics. Even low-range (BP, 120-129/80-84 mm Hg) prehypertension increased the risk of ESRD compared with optimal BP (RR, 1.44; 95% CI, 1.19-1.74), and the risk increased further with high-range (BP, 130-139/85-89 mm Hg) prehypertension (RR, 2.02; 95% CI, 1.70-2.40). The RR was significantly higher in the high-range compared with the low-range prehypertensive population (P = 0.01).


CONCLUSIONS
No access to individual patient-level data.


CONCLUSIONS
Prehypertension is associated with incident ESRD. The increased risk is driven largely by high-range prehypertension.
Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China.
Yuli
Y
Huang
Clinical Medicine Research Institute, the First People's Hospital of Shunde (the Affiliated Hospital at Shunde, Southern Medical University), Foshan, People's Republic of China.
Xiaoyan
X
Cai
Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China.
Jianyu
J
Zhang
Department of Cardiology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.
Weiyi
W
Mai
Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China.
Sheng
S
Wang
Clinical Medicine Research Institute, the First People's Hospital of Shunde (the Affiliated Hospital at Shunde, Southern Medical University), Foshan, People's Republic of China.
Yunzhao
Y
Hu
Department of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China. Electronic address: renhao67@aliyun.com.
Hao
H
Ren
Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China. Electronic address: dinglixu@fimmu.com.
Dingli
D
Xu
D000328:Adult; D000368:Aged; D001794:Blood Pressure; D001795:Blood Pressure Determination / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D058246:Prehypertension / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D012306:Risk; D018570:Risk Assessment
Prehypertension; chronic kidney disease (CKD); end-stage renal disease; high-normal blood pressure; kidney failure; meta-analysis