Differences in Kidney Function and Incident Hypertension: The Multi-Ethnic Study of Atherosclerosis

Background: Kidney disease and hypertension commonly coexist, yet the direction of their association is still debated. Objective: To evaluate whether early kidney dysfunction, mea-sured by serum cystatin C levels and urinary albumin excretion, predates hypertension in adults without clinically recognized kidney or cardiovascular disease. Design: Observational cohort study using data from 2000 to 2005. Setting: The MESA (Multi-Ethnic Study of Atherosclerosis), a com-munity-based study of subclinical cardiovascular disease in adults age 45 to 84 years. Participants: 2767 MESA participants without prevalent hyperten-sion, cardiovascular disease, or clinically recognized kidney disease (an estimated glomerular filtration rate 60 mL/min per 1.73 m2 or microalbuminuria). Measurements: Cystatin C was measured by using a nephelome