Association Between Hypertension and Kidney Function Decline: The Atherosclerosis Risk in Communities (ARIC) Study

Rationale & Objective The relationship between hypertension, antihypertension medication use, and change in glomerular filtration rate (GFR) over time among individuals with preserved GFR requires investigation. Study Design Observational study. Setting & Participants 14,854 participants from the Atherosclerosis Risk in Communities (ARIC) Study. Predictors Baseline hypertension status (1987-1989) was categorized according to the 2017 American College of Cardiology/American Heart Association Clinical Practice Guideline as normal blood pressure, elevated blood pressure, stage 1 hypertension, stage 2 hypertension without medication, or stage 2 hypertension with medication. Outcomes Slope of estimated GFR (eGFR) at 5 study visits over 30 years. Analytical Approach Mixed models with random intercepts and random slopes were fit to evaluate the association between baseline hypertension status and slope of eGFR. Results At baseline, 13.2%, 7.3%, and 19.4% of whites and 15.8%, 14.9%, and 39.9% of African Americans had stage 1 hypertension, stage 2 hypertension without medication, and stage 2 hypertension with medication. Compared with those with normal blood pressure, the annual eGFR decline was greater in people with higher blood pressure (whites: elevated blood pressure, −0.11 mL/min/1.73 m 2 ; stage 1 hypertension, −0.15 mL/min/1.73 m 2 ; stage 2 hypertension without medication, −0.36 mL/min/1.73 m 2 ; stage 2 hypertension with medication, −0.17 mL/min/1.73 m 2 ; African Americans: elevated blood pressure, −0.21 mL/min/1.73 m 2 ; stage 1 hypertension, −0.16 mL/min/1.73 m 2 ; stage 2 hypertension without medication, −0.50 mL/min/1.73 m 2 ; stage 2 hypertension with medication, −0.16 mL/min/1.73 m 2 ). The 30-year predicted probabilities of developing chronic kidney disease stage G3a+ with normal blood pressure, elevated blood pressure, stage 1 hypertension, stage 2 hypertension without medication, or stage 2 hypertension with medication among whites were 54.4%, 61.6%, 64.7%, 78.1%, and 70.9%, respectively, and 55.4%, 62.8%, 60.9%, 76.1%, and 66.6% among African Americans. Limitations Slope estimated using a maximum of 5 eGFR assessments; differential loss to follow-up. Conclusions Compared to normotension, baseline hypertension status was associated with faster kidney function decline over 30-year follow-up in a general population cohort. This difference was attenuated among people using antihypertensive medications.