Pulse Pressure and the Risk of End-Stage Renal Disease Among Chinese Adults in Singapore: The Singapore Chinese Health Study

Abstract

Background Although hypertension is an established risk factor for chronic kidney disease, less is known about the relationship of pulse pressure (PP), a measure of arterial stiffness, with chronic kidney disease. We investigated the association of systolic blood pressure (BP), diastolic BP, PP, and mean arterial pressure with the risk of end-stage renal disease (ESRD) in the prospective population-based Singapore Chinese Health Study. Methods and Results We used data from 30 636 participants who had BP measured at ages 46 to 85 years during follow-up I interviews between 1999 and 2004. Information on lifestyle factors was collected at recruitment from 1993 to 1998, and selected factors were updated at follow-up I. We identified 463 ESRD cases over an average 11.3 years of follow-up I by linkage with the nationwide Singapore Renal Registry. Cox proportional hazards regression models were used to assess the relations between different BP indexes and ESRD risk. Each BP index was positively associated with ESRD when studied individually. However, when PP was included as a covariate, systolic and diastolic BP and mean arterial pressure were no longer associated with ESRD. Conversely, PP remained significantly associated with ESRD risk in a dose-dependent manner (P_trend<0.001) after adjusting for systolic or diastolic BP. Compared with the lowest group (<45 mm Hg) of PP, the hazard ratio was 5.25 (95% CI, 3.52-7.84) for the highest group (≥85 mm Hg). The association between hypertension and ESRD risk was attenuated and no longer significant after adjusting for PP. Conclusions Our findings provide a basis for targeting reduction of arterial stiffness to decrease ESRD risk.

Keywords: Singapore Chinese Health Study; blood pressure; end‐stage renal disease; pulse pressure; systolic blood pressure.

Figure 1

Multivariable adjusted hazard ratios (HRs) for risk of end‐stage renal disease (ESRD) according to systolic blood pressure, diastolic blood pressure, pulse pressure, and mean arterial pressure. HRs were adjusted for age; sex; dialect; education level; body mass index; physical activity; smoking status; alcohol use; sleep duration; total energy intake; total protein intake; red meat consumption; coffee consumption; incense use; physician‐diagnosed diabetes mellitus, coronary artery disease, and stroke; and antihypertensive medication use.