Association of Achieved Blood Pressure After Treatment for Primary Aldosteronism With Long-term Kidney Function


Little is known regarding the association of blood pressure (BP) after treatment for primary aldosteronism (PA) (i.e., adrenalectomy and mineralocorticoid receptor antagonists) with long-term renal outcomes, and whether the association is independent of BP before treatment. Using a dataset from a nationwide registry of PA in Japan, we assessed whether achieved BP levels 6 months after treatment for PA are associated with annual changes in estimated glomerular filtration rate (eGFR), rapid eGFR decline, and incident chronic kidney disease (CKD) during the 5-year follow-up period. The cohort included 1266 PA patients. In multivariable linear regression including systolic BP (SBP) levels before treatment for PA, estimates (95% confidence interval [CI]) for annual changes in eGFR after month 6 associated with one-standard deviation (1-SD) higher SBP at month 6 were -0.08 (-0.15, -0.02) mL/min/1.73 m2/year. After multivariable adjustment, the estimate (95% CI) for annual changes in eGFR after month 6 was -0.12 (-0.21, -0.02) for SBP ≥ 130 mmHg vs. SBP < 130 mmHg at month 6. Among 537 participants without CKD at baseline, a 1-SD higher SBP was associated with a higher risk for incident CKD events (hazard ratio [95% CI]: 1.40 [1.00, 1.94]). Higher SBP after treatment for PA was associated with a higher risk for kidney dysfunction over time, independently of BP levels before treatment. Achieving SBP lower than 130 mmHg after treatment for PA may be linked to better kidney outcomes.

Authors: Tatsuya Haze, Yuichiro Yano, Yu Hatano, Kouichi Tamura, Isao Kurihara, Hiroki Kobayashi, Mika Tsuiki, Takamasa Ichijo, Norio Wada, Takuyuki Katabami, Koichi Yamamoto, Shintaro Okamura, Tatsuya Kai, Shoichiro Izawa, Yuichiro Yoshikawa, Masanobu Yamada, Yoshiro Chiba, Akiyo Tanabe, Mitsuhide Naruse, JPAS/JRAS Study Group
Keywords: renal outcome, eGFR decline, chronic kidney disease, CKD
DOI Number: 10.1038/s41371-021-00595-4      Publication Year: 2021

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