Elevated Pulse Pressure and Risk of Chronic Kidney Disease by Hypertension Status: A Longitudinal Study in Japanese Adults.

Introduction: Little is known about the relationship between pulse pressure (PP) and incident chronic kidney disease (CKD) in Asian populations, particularly when analyzed separately by hypertension status.

Aim: This study aimed to assess the association between PP and subsequent onset of CKD in Japanese adults.

Methods: This longitudinal study included middle-aged and older Japanese citizens who participated in administrative checkups (1998-2024) conducted by Zentsuji City. The relationship between PP (diastolic blood pressure subtracted from systolic blood pressure) and incident CKD (estimated glomerular filtration rate < 60 mL/min/1.73 m²) was evaluated by hypertension status, using the Weibull accelerated failure time model. PP was treated as a time-varying variable and categorized into < 40 (reference), 40-< 60, and ≥ 60 mmHg. In addition to the crude model, two adjusted models were created to control for potential confounders.

Results: Among 15,788 participants, 8881 (men: 42.7%) were examined in the study. The mean follow-up time was 6.21 years for non-hypertensive participants and 6.27 years for hypertensive participants. Higher PP was associated with higher rate of CKD incidence regardless of prevalent hypertension. In non-hypertensive participants, PP ≥ 60 mmHg had a 10% shorter time to CKD onset (95% confidence interval: 3-16%) compared with PP < 40 mmHg. In hypertensive participants, attenuated results were observed, with all 95% confidence intervals crossing the null value.

Conclusions: Elevated PP may serve as a useful indicator for CKD development in non-hypertensive Japanese subjects. Regular BP monitoring may assist in developing public health strategies for CKD prevention, especially among non-hypertensive Asian populations.