Prehypertension and Incidence of ESRD: a systematic review and meta-analysis

Am J Kidney Dis. 2014 Jan;63(1):76-83. doi: 10.1053/j.ajkd.2013.07.024. Epub 2013 Sep 26.


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.

Study design: Systematic review and meta-analysis of prospective cohort studies.

Setting & population: Adults with prehypertension.

Selection criteria for studies: 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.

Predictor: Prehypertension.

Outcomes: 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).

Limitations: No access to individual patient-level data.

Conclusions: Prehypertension is associated with incident ESRD. The increased risk is driven largely by high-range prehypertension.

Keywords: Prehypertension; chronic kidney disease (CKD); end-stage renal disease; high-normal blood pressure; kidney failure; meta-analysis.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Adult
  • Aged
  • Blood Pressure
  • Blood Pressure Determination / statistics & numerical data
  • Cohort Studies
  • Female
  • Humans
  • Incidence
  • Kidney Failure, Chronic* / epidemiology
  • Kidney Failure, Chronic* / etiology
  • Kidney Failure, Chronic* / physiopathology
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Prehypertension* / complications
  • Prehypertension* / diagnosis
  • Prehypertension* / epidemiology
  • Prehypertension* / physiopathology
  • Risk
  • Risk Assessment