Higher Systolic BP Linked to Cardiovascular Risk in CKD

Higher systolic blood pressure (SBP) was associated with greater cardiovascular disease (CVD) risk among adults with nonproteinuric chronic kidney disease (CKD) and no diabetes in a nationwide Japanese cohort study published in Hypertension Research. Among participants taking antihypertensive medication, however, the association was U-shaped, with risk also increasing at lower SBP levels.

Investigators analyzed Japan’s DeSC administrative claims and annual health-checkup database. The cohort included 287,238 adults with estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73 m² and negative or trace proteinuria on dipstick testing; patients with diabetes or previous CVD were excluded. Median age was 70 years, 39.0% were men, and 37.9% were receiving antihypertensive medication. Median follow-up was 3.3 years.

The primary outcome was a composite of myocardial infarction, stroke, heart failure, and atrial fibrillation. During follow-up, 40,548 composite events occurred. In the fully adjusted Cox model, each 10 mmHg increase in SBP was associated with a 5% higher hazard of the composite outcome (hazard ratio [HR], 1.05; 95% CI, 1.04-1.05).

Using 2017 ACC/AHA BP categories and normal BP as the reference, adjusted HRs were 1.03 (95% CI, 1.00-1.07) for elevated BP, 1.08 (95% CI, 1.05-1.11) for stage 1 hypertension, and 1.20 (95% CI, 1.17-1.24) for stage 2 hypertension. Restricted cubic spline analysis showed increasing CVD risk above approximately 130 mmHg. The positive association generally remained across sex, age, proteinuria, and eGFR subgroups, but the U-shaped pattern appeared among participants receiving antihypertensive medication.

The authors cautioned that the observational design cannot establish whether lower BP itself is harmful. Other limitations included single-time-point assessments of BP, eGFR, and proteinuria; dipstick rather than albumin-to-creatinine ratio testing; reliance on ICD-10 codes for outcomes; relatively short follow-up; and limited generalizability beyond the comparatively older Japanese cohort. They called for randomized trials to clarify the cardiovascular effects of BP lowering in this population.

Source: Suzuki Y, Nishikawa M, Kaneko H, et al. Blood pressure and cardiovascular risk in adults with non-proteinuric chronic kidney disease without diabetes. Hypertens Res. Published online September 10, 2026. doi:10.1038/s41440-026-02801-7