A retrospective cohort study of H-type hypertension and its influence on the prognostic effect in patients with non-dialysis CKD

Background The study aimed to investigate the impact of coexistence of hyperhomocysteinemia (HHcy) and hypertension (HTN), referred to as H-type hypertension on kidney outcomes and major adverse cardiovascular and cerebrovascular events (MACCEs) in patients with non-dialysis chronic kidney disease (CKD). Methods This retrospective study enrolled 2,558 non-dialysis CKD patients admitted to two medical centers in China between 2010 and 2022. The participants were divided into four groups according to baseline blood pressure and homocysteine levels: (1) normotension with normohomocysteinemia; (2) normotension with HHcy; (3) hypertension with normohomocysteinemia; and (4) H-type hypertension. Cox regression model was applied to assess the relationship between these groups and renal outcomes/MACCEs. Mediation analysis was performed to assess the influence of HHcy on the link between hypertension and the outcomes. Results Three hundred and eighty renal endpoint events and 211 MACCEs were recorded. The H-type hypertension group demonstrated higher incidence of renal events (age-adjusted incidence: 83.71/1,000 person-years vs. 24.50/1,000 person-years) and MACCEs (age-adjusted incidence: 41.28/1,000 person-years vs. 17.21/1,000 person-years) compared to the normotension with normohomocysteinemia group. After adjusting for confounders, H-type hypertension independently elevated the risk of kidney outcomes by 312% (HR = 4.12, 95% CI: 2.66–6.37) and MACCEs by 127% (HR = 2.27, 95% CI: 1.28–4.02). No statistically significant mediated effect of HHcy on the relationship between hypertension and renal outcomes or MACCEs was observed. Conclusion H-type hypertension is associated with renal deterioration and cardiovascular events in non-dialysis CKD patients, early detections of H-type hypertension are essential to enhancing the prognosis for CKD patients.