Hypertension is the leading risk factor for end-stage renal disease (ESRD). However, the association between sustained exposure to increased blood pressure (BP) and ESRD is not well established. This study investigated whether the cumulative hypertension burden is a substantial risk factor for ESRD. The incidence of ESRD among 2,144,801 participants identified from the Korean National Health Insurance Service database who had documented BP assessment data in their annual health check-up data from between 2006 and 2010, was determined. Over a median follow-up of 7.2 years, ESRD was identified in 1758 participants. Hypertension burden was defined as the cumulative exposure to hypertension (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg) during four consecutive follow-up periods and ranged from 0 to 4. The hypertension burden was as follows: 0 (n = 1,164,488), 77.6%; 1 (n = 292,377), 13.6%; 2 (n = 114,397), 5.3%; 3 (n = 52,671), 2.5%; and 4 (n = 20,886), 1.0%. Compared to the hypertension burden of 0, the adjusted hazard ratio for ESRD was 1.35, 1.54, 1.51, and 2.28 for hypertension burdens of 1, 2, 3, and 4, respectively. A positive dose-dependent relationship between hypertension burden and ESRD was found (P for interaction < 0.001). This association was maintained for sustained exposure to both systolic and diastolic hypertension burden. In conclusion, hypertension burden increases the risk of ESRD. Our study underlines the usefulness of a new assessment of the hypertension burden over a certain period for predicting the risk of ESRD in a large population-based cohort.

高血压是终末期肾病（ESRD）的主要危险因素。然而，持续暴露于血压升高 (BP) 与 ESRD 之间的关联尚未得到很好的确定。本研究调查了累积高血压负担是否是 ESRD 的重要危险因素。确定了从韩国国民健康保险服务数据库中确定的 2,144,801 名参与者中 ESRD 的发病率，这些参与者在 2006 年至 2010 年间的年度健康检查数据中记录了 BP 评估数据。在 7.2 年的中位随访中，1758 名参与者发现了 ESRD。高血压负担定义为连续四个随访期间高血压（收缩压≥140 mmHg或舒张压≥90 mmHg）的累积暴露量，范围为0至4。高血压负担如下：0（n  = 1,164,488)，77.6%；1 ( n  = 292,377), 13.6%; 2 ( n  = 114,397), 5.3%; 3 ( n  = 52,671), 2.5%; 和 4 ( n  = 20,886), 1.0%。与高血压负担为 0 相比，对于高血压负担为 1、2、3 和 4 的 ESRD，调整后的风险比分别为 1.35、1.54、1.51 和 2.28。高血压负担与 ESRD 呈正剂量依赖关系（P对于交互 < 0.001)。这种关联在持续暴露于收缩期和舒张期高血压负担的情况下得以维持。总之，高血压负担增加了 ESRD 的风险。我们的研究强调了对特定时期内高血压负担的新评估对于预测大型人群队列中 ESRD 风险的有用性。