Prehypertension and Incidence of ESRD: A Systematic Review and Meta-analysis

Background: Studies of the association of prehypertension with the incidence of end-stage renal disease (ESRD) after adjusting for other cardiovascular risk factors have shown controversial results. Study Design: Systematic review and meta-analysis of prospective cohort studies. Setting & Population: Adults with prehypertension. Selection Criteria for Studies: Studies evaluating the association of prehypertension with the incidence of ESRD identified by searches in PubMed, EMBASE, and Cochrane Library databases and conference proceedings, without language restriction. Predictor: Prehypertension. Outcomes: The relative risks (RRs) of ESRD were calculated and reported with 95% CIs. Subgroup analyses were conducted according to blood pressure (BP), age, sex, ethnicity, and study characteristics. Results: Data from 1,003,793 participants were derived from 6 prospective cohort studies. Compared with optimal BP, prehypertension significantly increased the risk of ESRD (RR, 1.59; 95% CI, 1.39-1.91). In subgroup analyses, prehypertension significantly predicted higher ESRD risk across age, sex, ethnicity, and study characteristics. Even low-range (BP, 120-129/80-84 mm Hg) prehypertension increased the risk of ESRD compared with optimal BP (RR, 1.44; 95% CI, 1.19-1.74), and the risk increased further with high-range (BP, 130-139/85-89 mm Hg) prehypertension (RR, 2.02; 95% CI, 1.70-2.40). The RR was significantly higher in the high-range compared with the low-range prehypertensive population (P = 0.01). Limitations: No access to individual patient-level data. Conclusions: Prehypertension is associated with incident ESRD. The increased risk is driven largely by high-range prehypertension. (C) 2013 by the National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.