Abstract Body: Introduction: CKM consists of obesity, metabolic risk factors, chronic kidney disease (CKD) and cardiovascular disease (CVD). Hypertension is a key factor for stage 2 CKM and it is most common among Black adults. A better understanding of the role of hypertension in CKM progression is needed.

Aim: To estimate the risk of progression to stage 4 CKM in Black adults, overall and among those with hypertension, in the Jackson Heart Study (JHS).

Methods: We included 2,118 Black adults in the JHS without clinical CVD at baseline. Participants were categorized into: Stage 1 CKM: overweight/obesity, abdominal obesity or dysfunctional adipose tissue with no metabolic risk factors including hypertension; Stage 2 CKM: metabolic risk factors including hypertension, diabetes, hypertriglyceridemia, metabolic syndrome or CKD; Stage 3 CKM: subclinical CVD; or Stage 4 CKM: Clinical CVD. The incidence rate of stage 4 CKM for participants in stages 1, 2 and 3 CKM were estimated. We used Cox proportional hazards regression to estimate hazard ratios (HRs) for incident stage 4 CKM.

Results: At baseline, 20%, 69%, and 11% of participants were in stages 1, 2 and 3 CKM. The prevalence of hypertension in stage 2 CKM and stage 3 CKM were 80% and 95%, respectively. The incidence rate per 1,000 person-years of stage 4 CKM for participants with stage 2 CKM and hypertension was 7.5 (95% CI 6.1, 8.9), and for stage 3 CKM and hypertension was 26.6 (95% CI 19.8, 33.3) (Table). The adjusted HRs of developing stage 4 CKM were 3.25 (95%CI: 1.56-6.80) and 5.11 (95% CI 2.05-12.78) for participants with stage 2 and 3 CKM with hypertension versus stage 1 CKM, respectively.

Conclusion: The majority of JHS participants with stages 2 and 3 CKM had hypertension, which was associated with an increased risk for progressing to stage 4 CKM when compared to stage 1 CKM participants.