Background and Aims Little is known about the relationship between pulse pressure (PP) and incident chronic kidney disease (CKD) in Asian populations, particularly when analyzed separately by hypertension status. This study aims to assess the association between PP and the subsequent incidence of CKD in Japanese adults.

Methods This longitudinal study included middle-aged and older Japanese citizens screened by the administrative checkup (1998–2024) conducted by Zentsuji City. The relationship between PP (subtracting diastolic blood pressure [BP] from systolic BP) and incident CKD (estimated filtration rate of <60 mL/min/1.73m2) was evaluated by hypertension status, using the Weibull accelerated failure time model. PP was treated as time-varying, and categorized into <40 (reference), 40–<60, and ≥60 mmHg. In addition to the crude model, two adjusted models were performed, controlling for potential confounders.

Results Of 15788 participants, 8881 (men: 42.7%) remained in this study. The mean follow-up time was 6.21 years for non-hypertension and 6.27 years for hypertension. The higher the PP, the higher the incidence rate regardless of prevalent hypertension. In non-hypertensive participants with PP ≥60 mmHg, a 10% shorter survival to CKD (95% confidence interval: 3%–16%) was observed, compared to PP <40 mmHg. In hypertensive participants, attenuated results were observed, with all 95% confidence intervals crossing the null value.

Conclusions Higher PP may serve as a handy indicator for the development of CKD in non-hypertensive Japanese populations. Regular BP monitoring may assist in considering strategies for the public health prevention of CKD, especially for non-hypertensive Asian populations.

Yukari Okawa is an employee of Zentsuji City.

This study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

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The data was anonymized before receipt. The Ethics Committee of Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences and Okayama University Hospital approved this study (No. K1708-040). The Ethics committee waived the need for informed consent. This research followed the Declaration of Helsinki and Japanese Ethical Guidelines for Medical and Biological Research involving Human Subjects.

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All data generated or analyzed during this study are included in this published article and its supplementary information files.