Figure 221

Blood pressure levels and rates of end-stage renal disease (ESRD). A, Line graph showing Kaplan-Meier estimates of ESRD rates; 15-year follow-up. B, Age-adjusted 16-year incidence of all-cause ESRD in men in the Multiple Risk Factor Intervention Trial (MRFIT). Large-scale epidemiologic studies indicate a progressive increase in the risk for developing ESRD as a function of systolic blood pressure levels. Follow-up of nearly 12,000 male veterans in the United States established that systolic blood pressure above 165 mm Hg at the initial visit was predictive of progressively higher risk of ESRD over a 15-year follow-up period [18]. Similarly, follow-up studies after 16 years of more than 300,000 men in MRFIT demonstrated a progressive increase in the risk for ESRD, most pronounced in blacks [19]. These data suggest that blood pressure levels predict future renal disease. However, it remains uncertain whether benign essential hypertension itself induces a primary renal lesion (hypertensive renal disease nephrosclerosis) or acts as a catalyst in patients with other primary renal disease, otherwise not detected at initial screening. SBP—systolic blood pressure. (Panel A from Perry and coworkers [18]; with permission.)

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