A new study published in Scientific Reports has found that pulse pressure (PP) is not only strongly associated with chronic kidney disease (CKD), but it may also be even more accurate than blood pressure as a predictor of the disease’s progression. 

What The Study Researchers Did

CKD has well-known links to heart disease, death, and an astronomical burden in terms of healthcare costs. High blood pressure, hyperglycemia, and smoking are considered significant risk factors for CKD progression. Blood pressure, both systolic (SBP) and diastolic (DBP), have long been considered the best predictive factors for that progression.

Pulse pressure, calculated by subtracting DBP from SBP, has been used as a potential marker for cardiovascular disease, heart failure, and stroke, but few studies have explored pulse pressure as a risk factor for CKD progression.

For the new study, researchers analyzed annual health checkup data from 2008 to 2018 for 1,042 patients with CKD, selected from a previous study in the Nagasaki Prefecture of Japan. The average age of the patients was 64.5 years, and 51.6% of the cohort was male.

What They Found

Patients were divided into four categories based on their pulse pressure at baseline:

• 278 patients (26.7%) had 48 mmHg or less 
• 260 patients (25.0%) had between 49 and 56 mmHg
• 245 patients (23.5%) had between 57 and 65 mmHg 
• 259 patients (24.9%) had between 66 or more mmHg 

The team found 241 cases of CKD progression over an average of 4.66 years, with a  significant increase in progression per 10 mmHg of pulse pressure. Results were similar even after controlling for age, baseline kidney filtration rate, blood pressure medications, diabetes, drinking, dyslipidemia, hemoglobin, hyperuricemia, obesity, sex, and smoking.  

What It Means

According to the study authors, the association may be due to patients with high pulse pressure having stiff blood vessels that lead to microvascular kidney disease. Another theory is that low DBP has resulted in uncontrolled blood pressure. “As aortic stiffness increases, indicated by increased PP,” they wrote, “the kidney experiences greater pressure fluctuation and wave reflection…which might cause microvascular ischemia and renal tissue damage.”

Since the study design involved retrospective data analysis, the research team was unable to observe a direct causal connection between pulse pressure and CKD progression, but the analysis results were significant, and warrant even more rigorous investigation. 

*Jeremias, S. (2021, Dec. 21). Study: Pulse Pressure Could Serve as Predictive Marker for CKD Progression. American Journal of Managed Care.    https://www.ajmc.com/view/study-pulse-pressure-could-serve-as-predictive-marker-for-ckd-progression