{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T01:46:56Z","timestamp":1785808016072,"version":"3.56.0"},"reference-count":35,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2019,4,9]],"date-time":"2019-04-09T00:00:00Z","timestamp":1554768000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>Background: Hypertension is a main risk factor for premature death. Although blood pressure is a complex trait, we have shown that the activity of the ATP-generating enzyme creatine kinase (CK) is a significant predictor of blood pressure and of failure of antihypertensive drug therapy in the general population. In this report, we systematically review the evidence on the association between this new risk factor CK and blood pressure outcomes. Method: We used a narrative synthesis approach and conducted a systematic search to include studies on non-pregnant adult humans that address the association between plasma CK and blood pressure outcomes. We searched electronic databases and performed a hand search without language restriction. We extracted data in duplo. The main outcome was the association between CK and blood pressure as continuous measures. Other outcomes included the association between CK and blood pressure categories (normotension and hypertension, subdivided in treated controlled, treated uncontrolled, and untreated hypertension). Results: We retrieved 139 reports and included 11 papers from 10 studies assessing CK in 34,578 participants, men and women, of African, Asian, and European ancestry, aged 18 to 87 years. In 9 reports, CK was associated with blood pressure levels, hypertension (vs. normotension), and\/or treatment failure. The adjusted increase in systolic blood pressure (mmHg\/log CK increase) was reported between 3.3 [1.4 to 5.2] and 8.0 [3.3 to 12.7] and the odds ratio of hypertension with high vs. low CK ranged between 1.2 and 3.9. In addition, CK was a strong predictor of treatment failure in the general population, with an adjusted odds ratio of 3.7 [1.2 to 10.9]. Discussion: This systematic review largely confirms earlier reports that CK is associated with blood pressure and failure of antihypertensive therapy. Further work is needed to address whether this new risk factor is useful in clinical medicine.<\/jats:p>","DOI":"10.3390\/medsci7040058","type":"journal-article","created":{"date-parts":[[2019,4,10]],"date-time":"2019-04-10T03:47:36Z","timestamp":1554868056000},"page":"58","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Creatine Kinase and Blood Pressure: A Systematic Review"],"prefix":"10.3390","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7434-0038","authenticated-orcid":false,"given":"L. M.","family":"Brewster","sequence":"first","affiliation":[{"name":"Creatine Kinase Foundation, POB 23639, 1100 EC Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5117-4308","authenticated-orcid":false,"given":"F. A.","family":"Karamat","sequence":"additional","affiliation":[{"name":"Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. A.","family":"van Montfrans","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,4,9]]},"reference":[{"key":"ref_1","unstructured":"WHO (2019, February 11). Raised blood pressure. Available online: https:\/\/www.who.int\/gho\/ncd\/risk_factors\/blood_pressure_prevalence_text\/en\/."},{"key":"ref_2","unstructured":"NCD Risk Factor Collaboration (2017). Worldwide trends in blood pressure from 1975 to 2015: A pooled analysis of 1479 population-based measurement studies with 19\u00b71 million participants. Lancet, 389, 37\u201355."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2224","DOI":"10.1016\/S0140-6736(12)61766-8","article-title":"A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990\u20132010: A systematic analysis for the Global Burden of Disease Study 2010","volume":"380","author":"Lim","year":"2012","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"NCD Risk Factor Collaboration (2018). Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: A pooled analysis of 1018 population-based measurement studies with 88.6 million participants. Int. J. Epidemiol., 47, 872\u2013883i.","DOI":"10.1093\/ije\/dyy016"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1537","DOI":"10.1097\/00004872-200018110-00002","article-title":"Is greater tissue activity of creatine kinase the genetic factor increasing hypertension risk in black people of sub-Saharan African descent?","volume":"18","author":"Brewster","year":"2000","journal-title":"J. Hypertens."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2034","DOI":"10.1161\/CIRCULATIONAHA.105.584490","article-title":"Creatine kinase activity is associated with blood pressure","volume":"114","author":"Brewster","year":"2006","journal-title":"Circulation"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1097\/HJH.0b013e32835f5c29","article-title":"Creatine kinase is associated with failure of hypertension treatment","volume":"31","author":"Oudman","year":"2013","journal-title":"J. Hypertens."},{"key":"ref_8","unstructured":"Aromataris, E., and Munn, Z. (2017). Chapter 5: Systematic reviews of prevalence and incidence. Joanna Briggs Institute Reviewer\u2019s Manual, The Joanna Briggs Institute. Available online: https:\/\/reviewersmanual.joannabriggs.org\/."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1177\/1356389008097871","article-title":"Testing methodological guidance on the conduct of narrative synthesis in systematic reviews: Effectiveness of interventions to promote smoke alarm ownership and function","volume":"15","author":"Rodgers","year":"2009","journal-title":"Evaluation"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1016\/j.ahj.2007.06.008","article-title":"Distribution of creatine kinase in the general population: Implications for statin therapy","volume":"154","author":"Brewster","year":"2007","journal-title":"Am. Heart J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1097\/HJH.0b013e32834068e0","article-title":"Creatine kinase activity and blood pressure in a normal population: The Troms\u00f8 study","volume":"29","author":"Johnsen","year":"2011","journal-title":"J. Hypertens."},{"key":"ref_12","unstructured":"Sanjay Kumar, H.R. (2013). A study to determine the association between creatine kinase and hypertension in a study group of age >40 years. [Ph.D. Thesis, Rajiv Gandhi University of Health Sciences]."},{"key":"ref_13","first-page":"36","article-title":"Creatine kinase increases in adults with uncontrolled hypertension","volume":"33","author":"Luman","year":"2014","journal-title":"Univ. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e4344","DOI":"10.1097\/MD.0000000000004344","article-title":"Creatine kinase in the U.S. population: Impact of demographics, comorbidities, and body composition on the normal range","volume":"95","author":"George","year":"2016","journal-title":"Medicine"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Mels, C.M., van Zyl, C., and Huisman, H.W. (2016). Cardiovascular function is not associated with creatine kinase activity in a black African population: The SABPA study. BMC Cardiovasc, Disord., 16.","DOI":"10.1186\/s12872-016-0315-2"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Emokpae, M.A., and Nwagbara, G.O.N.A. (2017). Serum Creatine Kinase-MB Isoenzyme Activity among Subjects with Uncomplicated Essential Hypertension: Any Sex Differences. Med. Sci., 27.","DOI":"10.3390\/medsci5020008"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Yen, C.H., Wang, K.T., Lee, P.Y., Liu, C.C., Hsieh, Y.C., Kuo, J.Y., Bulwer, B.E., Hung, C.L., Chang, S.C., and Shih, S.C. (2017). Gender-differences in the associations between circulating creatine kinase, blood pressure, body mass and non-alcoholic fatty liver disease in asymptomatic Asians. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0179898"},{"key":"ref_18","first-page":"BC19","article-title":"Serum Creatine Kinase Activity among Hypertensive Patients and its Role as a Predictor for Failure of Antihypertensive Treatment","volume":"11","author":"Sukul","year":"2018","journal-title":"J. Clin. Diagn. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1007\/s00415-008-0651-y","article-title":"Hypertension risk in idiopathic hyperCKemia","volume":"255","author":"Brewster","year":"2008","journal-title":"J. Neurol."},{"key":"ref_20","first-page":"635","article-title":"International Federation of Clinical Chemistry and Laboratory Medicine (IFCC). IFCC primary reference procedures for the measurement of catalytic activity concentrations of enzymes at 37 degrees C. Part 2. Reference procedure for the measurement of catalytic concentration of creatine kinase","volume":"40","author":"Schumann","year":"2002","journal-title":"Clin. Chem. Lab. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1309\/UREA-EU4H-UM16-3B2W","article-title":"Evaluation of the Beckman Coulter LX20 Clinical Chemistry Analyzer","volume":"31","author":"Mikolaenko","year":"2000","journal-title":"Lab. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1515\/cclm-2016-0220","article-title":"Analytical performance of 17 general chemistry analytes across countries and across manufacturers in the INPUtS project of EQA organizers in Italy, the Netherlands, Portugal, United Kingdom and Spain","volume":"55","author":"Weykamp","year":"2017","journal-title":"Clin. Chem. Lab. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1373\/clinchem.2013.220376","article-title":"Participating Laboratories. Measurements for 8 common analytes in native sera identify inadequate standardization among 6 routine laboratory assays","volume":"60","author":"Stepman","year":"2014","journal-title":"Clin. Chem."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1007\/s00769-006-0254-1","article-title":"Defining and measuring biological activity: Applying the principles of metrology","volume":"12","author":"Jackson","year":"2007","journal-title":"Accred Qual. Assur."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Brewster, L.M., Coronel, C.M., Sluiter, W., Clark, J.F., and van Montfrans, G.A. (2012). Ethnic differences in tissue creatine kinase activity: An observational study. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0032471"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"6551","DOI":"10.1038\/srep06551","article-title":"Creatine kinase inhibits ADP-induced platelet aggregation","volume":"4","author":"Horjus","year":"2014","journal-title":"Sci. Rep."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"292","DOI":"10.21037\/atm.2018.07.15","article-title":"Creatine kinase, energy reserve, and hypertension: From bench to bedside","volume":"6","author":"Brewster","year":"2018","journal-title":"Ann. Transl. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1093\/ajh\/hpv078","article-title":"The effect of creatine kinase inhibition on contractile properties of human resistance arteries","volume":"29","author":"Taherzadeh","year":"2015","journal-title":"Am. J. Hypertens."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1111\/jch.13182","article-title":"Creatine kinase and renal sodium excretion in African and European men on a high sodium diet","volume":"20","author":"Brewster","year":"2018","journal-title":"J. Clin. Hypertens (Greenwich)"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1161\/HYPERTENSIONAHA.113.01352","article-title":"Resistance artery creatine kinase mRNA and blood pressure in humans","volume":"63","author":"Karamat","year":"2014","journal-title":"Hypertension"},{"key":"ref_31","first-page":"442:24","article-title":"Creatine kinase as a marker of obesity in a multi-ethnic population","volume":"15","author":"Haan","year":"2017","journal-title":"Mol. Cell Endocrinol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1053\/meta.2002.31324","article-title":"Skeletal muscle characteristics predict body fat gain in response to overfeeding in never-obese young men","volume":"51","author":"Sun","year":"2002","journal-title":"Metabolism"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1111\/jch.12422","article-title":"Creatine kinase as predictor of blood pressure and hypertension. Is it all about body mass index? A follow-up study of 250 patients","volume":"16","author":"Johnsen","year":"2014","journal-title":"J. Clin. Hypertens."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/0735-1097(92)90076-Y","article-title":"Creatine kinase kinetics studied by phosphorus-31 nuclear magnetic resonance in a canine model of chronic hypertension-induced cardiac hypertrophy","volume":"19","author":"Osbakken","year":"1992","journal-title":"J. Am. Coll Cardiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2418","DOI":"10.1097\/HJH.0000000000001090","article-title":"Creatine kinase inhibition lowers systemic arterial blood pressure in spontaneously hypertensive rats: A randomized controlled trial","volume":"34","author":"Karamat","year":"2016","journal-title":"J. Hypertens."}],"container-title":["Medical Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3271\/7\/4\/58\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T12:44:07Z","timestamp":1760186647000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3271\/7\/4\/58"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,4,9]]},"references-count":35,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2019,4]]}},"alternative-id":["medsci7040058"],"URL":"https:\/\/doi.org\/10.3390\/medsci7040058","relation":{},"ISSN":["2076-3271"],"issn-type":[{"value":"2076-3271","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,4,9]]}}}