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Peer-reviewedCC BY 4.0Hypertension Research

Blood pressure and cardiovascular risk in adults with non-proteinuric chronic kidney disease without diabetes

  • Yuta Suzuki1,2
  • Masachika Nishikawa1
  • Hidehiro Kaneko1,3
  • Akira Okada4
  • Toshiyuki Ko1
  • Katsuhito Fujiu1,3
  • Norifumi Takeda1
  • Hiroyuki Morita1,5
  • Naoki Nakagawa6
  • Tatsuhiko Azegami7
  • Kaori Hayashi7
  • Takashi Yokoo8
3 more authors
  • Koichi Node9
  • Hideo Yasunaga10
  • Norihiko Takeda1
10 affiliations
  1. 1The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
  2. 2Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Saitama, Japan
  3. 3The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan
  4. 4Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
  5. 5International University of Health and Welfare, Tokyo, Japan
  6. 6Division of Cardiology and Nephrology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan
  7. 7Division of Nephrology, Endocrinology, and Metabolism, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
  8. 8Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
  9. 9Department of Cardiovascular Medicine, Saga University, Saga, Japan
  10. 10The Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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Abstract

We investigated the association between blood pressure (BP) and the risk of cardiovascular disease (CVD) in individuals with non-proteinuric chronic kidney disease (CKD) without diabetes. Using a large-scale nationwide administrative claims and health checkup database in Japan, we identified 287,238 non-diabetic adults with an estimated glomerular filtration rate <60 mL/min/1.73 m2 and negative/trace proteinuria. We examined the association between BP and CVD events by modeling BP both as a continuous variable and as a categorical variable according to the 2017 ACC/AHA guideline classification. The primary outcome was a composite of myocardial infarction, stroke, heart failure, and atrial fibrillation. Multivariable Cox regression analyses showed that higher systolic BP (SBP) was associated with increased CVD risk (hazard ratio [HR] 1.05 per 10 mmHg; 95% CI 1.04–1.05). Compared with normal BP, the HRs were 1.03 (95% CI 1.00–1.07) for elevated BP, 1.08 (1.05–1.11) for stage 1 hypertension, and 1.20 (1.17–1.24) for stage 2 hypertension. Restricted cubic spline analysis showed an increase in CVD risk at SBP levels above ~130 mmHg. However, among individuals receiving antihypertensive medication, a U-shaped association was observed, with an increased risk also evident at SBP levels below ~130 mmHg. In individuals with non-proteinuric CKD without diabetes, higher SBP was positively associated with increased cardiovascular risk. However, a U-shaped association observed among individuals receiving antihypertensive treatment suggests that the relationship between BP and cardiovascular risk may be complex in this population, highlighting the potential importance of individualized clinical assessment.

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Cite

BibTeXRIS
BibTeX
@article{suzuki2026blood,
  title = {{Blood pressure and cardiovascular risk in adults with non-proteinuric chronic kidney disease without diabetes}},
  author = {Yuta Suzuki and Masachika Nishikawa and Hidehiro Kaneko and Akira Okada and Toshiyuki Ko and Katsuhito Fujiu and Norifumi Takeda and Hiroyuki Morita and Naoki Nakagawa and Tatsuhiko Azegami and Kaori Hayashi and Takashi Yokoo and Koichi Node and Hideo Yasunaga and Norihiko Takeda},
  journal = {Hypertension Research},
  year = {2026},
  month = sep,
  doi = {10.1038/s41440-026-02801-7},
  url = {https://doi.org/10.1038/s41440-026-02801-7},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Blood pressure and cardiovascular risk in adults with non-proteinuric chronic kidney disease without diabetes
AU  - Yuta Suzuki
AU  - Masachika Nishikawa
AU  - Hidehiro Kaneko
AU  - Akira Okada
AU  - Toshiyuki Ko
AU  - Katsuhito Fujiu
AU  - Norifumi Takeda
AU  - Hiroyuki Morita
AU  - Naoki Nakagawa
AU  - Tatsuhiko Azegami
AU  - Kaori Hayashi
AU  - Takashi Yokoo
AU  - Koichi Node
AU  - Hideo Yasunaga
AU  - Norihiko Takeda
PY  - 2026
DA  - 2026/09/10
JO  - Hypertension Research
DO  - 10.1038/s41440-026-02801-7
UR  - https://doi.org/10.1038/s41440-026-02801-7
AB  - We investigated the association between blood pressure (BP) and the risk of cardiovascular disease (CVD) in individuals with non-proteinuric chronic kidney disease (CKD) without diabetes. Using a large-scale nationwide administrative claims and health checkup database in Japan, we identified 287,238 non-diabetic adults with an estimated glomerular filtration rate <60 mL/min/1.73 m2 and negative/trace proteinuria. We examined the association between BP and CVD events by modeling BP both as a continuous variable and as a categorical variable according to the 2017 ACC/AHA guideline classification. The primary outcome was a composite of myocardial infarction, stroke, heart failure, and atrial fibrillation. Multivariable Cox regression analyses showed that higher systolic BP (SBP) was associated with increased CVD risk (hazard ratio [HR] 1.05 per 10 mmHg; 95% CI 1.04–1.05). Compared with normal BP, the HRs were 1.03 (95% CI 1.00–1.07) for elevated BP, 1.08 (1.05–1.11) for stage 1 hypertension, and 1.20 (1.17–1.24) for stage 2 hypertension. Restricted cubic spline analysis showed an increase in CVD risk at SBP levels above ~130 mmHg. However, among individuals receiving antihypertensive medication, a U-shaped association was observed, with an increased risk also evident at SBP levels below ~130 mmHg. In individuals with non-proteinuric CKD without diabetes, higher SBP was positively associated with increased cardiovascular risk. However, a U-shaped association observed among individuals receiving antihypertensive treatment suggests that the relationship between BP and cardiovascular risk may be complex in this population, highlighting the potential importance of individualized clinical assessment.
SN  - 0916-9636
SN  - 1348-4214
ER  -