Association of isolated systolic and diastolic hypertension with moderately increased albuminuria: the Korea National Health and Nutrition Examination Survey.

Abstract

Background: Studies show variable results on health outcomes of isolated diastolic hypertension (IDH); however, data are scarce on its association with early kidney injury.

Methods: We analyzed the Korea National Health and Nutrition Examination Survey data (2011-2014 and 2019-2024) in adults ≥19 years. After excluding those taking antihypertensive medication or with established kidney disease, participants were categorized into normal blood pressure (BP [mmHg]; systolic BP [SBP] <120 and diastolic BP [DBP] <80), elevated BP (SBP 120 to <130 and DBP <80), stage 1 hypertension (SBP 130 to <140 or DBP 80 to <90 but not stage 2 hypertension), and stage 2 hypertension (SBP ≥140 or DBP ≥90) according to the 2025 American Heart Association/American College of Cardiology guidelines. Stage 1 and 2 hypertension was further classified as IDH, isolated systolic hypertension (ISH), or systolic-diastolic hypertension (SDH). Moderately increased albuminuria was defined as urine albumin-to-creatinine ratio of 30-<300 mg/g.

Results: Among 33,638 participants (mean age, 43.2 years; 47.9% female), multivariable-adjusted ORs (95% CIs) for moderately increased albuminuria were 1.45 (1.18-1.78) for stage 1 IDH, 1.66 (1.21-2.28) for stage 1 ISH, 2.09 (1.60-2.74) for stage 1 SDH, and 3.38 (2.85-4.01) for stage 2 hypertension. In age-stratified analysis, stage 1 IDH showed 1.37- and 1.58-fold higher odds of moderately increased albuminuria in participants aged <50 and ≥50 years, respectively.

Conclusion: IDH, even at stage 1, was associated with moderately increased albuminuria, suggesting it may not be benign. Longitudinal studies are needed to determine whether IDH predicts subsequent kidney injury and whether early attention to elevated DBP modifies kidney and cardiovascular outcomes.