What is the relationship between end stage kidney disease risk and hypertension?
Of the American population, 15% have kidney disease, and more than 80% of patients with an estimated GFR <60 mL/min per 1.73 m 2 have hypertension. Uncontrolled hypertension predisposes to ESKD.
The Multiple Risk Factor Intervention Trial (MRFIT) was a randomized, multicenter trial to prevent coronary artery disease in males by treating hypertension, hyperlipidemia, and tobacco abuse. Investigators followed these patients for several decades. Compared with optimal BPs, those patients with baseline systolic pressures ≥160 mm Hg had at least a 6-fold higher risk of progressing to ESKD. Poor African American men were at particularly high risk for developing ESKD. A more recent trial showed that, compared to optimal BPs, patients with prehypertension had 62% to 98% increased relative risk for developing ESKD. Those patients with stage I and II hypertension had a 2.5-fold and nearly 4-fold risk, respectively. Using predialysis BP recordings, patients who undergo long-term hemodialysis are nearly all hypertensive (86%), and only 30% of these patients have controlled BPs. However, only one-third of hemodialysis patients are hypertensive when ambulatory BP recordings are used.