title: Blood Pressure, Proteinuria, and Renal Function Decline: Associations in a Large Community-Based Population.
abstract: BACKGROUND
  Hypertension and proteinuria are risk factors for adverse renal outcomes in patients with chronic kidney disease. This study investigated the associations of blood pressure and proteinuria on renal function in a community-based population.
  
  
  METHODS
  We analyzed data from a nationwide database of 141,514 subjects who participated in the annual "Specific Health Check and Guidance in Japan" checkup in 2008 and 2010. The study subjects were aged between 29 and 74 years, and the cohort comprised 40% men. We examined relationships between blood pressure levels, proteinuria at baseline, and the 2-year change in the estimated glomerular filtration rate (eGFR), which was determined using the Japanese equation.
  
  
  RESULTS
  After adjusting for possible confounders, the change in the eGFR was inversely correlated with systolic blood pressure (SBP), but not diastolic blood pressure (DBP), at baseline, irrespective of the presence of proteinuria. Compared with the lowest SBP sixtile (≤118mm Hg), eGFRs declined significantly at SBPs ≥ 134mm Hg in subjects with proteinuria, while eGFRs declined significantly at SBPs ≥ 141mm Hg in those without proteinuria. At the same SBPs, renal function decline was faster and the risk for incident renal insufficiency was higher in subjects with proteinuria compared with those without proteinuria.
  
  
  CONCLUSIONS
  This study showed that a difference in SBP, but not DBP, is independently associated with a rapid eGFR decline in the general Japanese population, and that the association of SBP on the decline of renal function was greater in subjects with proteinuria compared with those without proteinuria.
authors: Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan;
authors: Atsushi
authors: A
authors: Hirayama
authors: Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan; Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Checkup, The Ministry of Health, Labour and Welfare of Japan, Fukushima, Japan. kkonta@med.id.yamagata-u.ac.jp.
authors: Tsuneo
authors: T
authors: Konta
authors: Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan;
authors: Keita
authors: K
authors: Kamei
authors: Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan;
authors: Kazuko
authors: K
authors: Suzuki
authors: Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan;
authors: Kazunobu
authors: K
authors: Ichikawa
authors: Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Checkup, The Ministry of Health, Labour and Welfare of Japan, Fukushima, Japan.
authors: Shouichi
authors: S
authors: Fujimoto
authors: Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Checkup, The Ministry of Health, Labour and Welfare of Japan, Fukushima, Japan.
authors: Kunitoshi
authors: K
authors: Iseki
authors: Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Checkup, The Ministry of Health, Labour and Welfare of Japan, Fukushima, Japan.
authors: Toshiki
authors: T
authors: Moriyama
authors: Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Checkup, The Ministry of Health, Labour and Welfare of Japan, Fukushima, Japan.
authors: Kunihiro
authors: K
authors: Yamagata
authors: Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Checkup, The Ministry of Health, Labour and Welfare of Japan, Fukushima, Japan.
authors: Kazuhiko
authors: K
authors: Tsuruya
authors: Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Checkup, The Ministry of Health, Labour and Welfare of Japan, Fukushima, Japan.
authors: Kenjiro
authors: K
authors: Kimura
authors: Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Checkup, The Ministry of Health, Labour and Welfare of Japan, Fukushima, Japan.
authors: Ichiei
authors: I
authors: Narita
authors: Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Checkup, The Ministry of Health, Labour and Welfare of Japan, Fukushima, Japan.
authors: Masahide
authors: M
authors: Kondo
authors: Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Checkup, The Ministry of Health, Labour and Welfare of Japan, Fukushima, Japan.
authors: Koichi
authors: K
authors: Asahi
authors: Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Checkup, The Ministry of Health, Labour and Welfare of Japan, Fukushima, Japan.
authors: Issei
authors: I
authors: Kurahashi
authors: Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Checkup, The Ministry of Health, Labour and Welfare of Japan, Fukushima, Japan.
authors: Yasuo
authors: Y
authors: Ohashi
authors: Steering Committee of Research on Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Checkup, The Ministry of Health, Labour and Welfare of Japan, Fukushima, Japan.
authors: Tsuyoshi
authors: T
authors: Watanabe
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D016208:Databases, Factual; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D007564:Japan / Q000453:epidemiology; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011507:Proteinuria / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D012307:Risk Factors; D013997:Time Factors
keywords: blood pressure; cohort study; hypertension; renal function.