Association between hypertension and incidence of cardiovascular disease events in young adults with type 2 diabetes: a nationwide cohort study

Although young-onset type 2 diabetes is more prevalent than before, evidence on the management of hypertension in this population is limited. We aimed to evaluate the association between hypertension status and the risk of cardiovascular disease. This retrospective cohort study included 173,483 patients (aged 20–39 years; median follow-up 7.1 years) with type 2 diabetes who were not on antihypertensive medication and underwent health examinations between January 2009 and December 2012. The participants were categorized according to their hypertension status as follows: normal blood pressure, elevated blood pressure, stage 1 isolated systolic hypertension (ISH), stage 1 isolated diastolic hypertension (IDH), stage 1 systolic and diastolic hypertension (SDH), stage 2 ISH, stage 2 IDH, and stage 2 SDH. Compared to those with normal blood pressure, patients with young-onset type 2 diabetes with stage 1 IDH (hazard ratio [HR] 1.14, 95% confidence interval [CI] 1.02–1.28), stage 1 SDH (HR 1.34, 95% CI 1.20–1.49), stage 2 ISH (HR 1.56, 95% CI 1.30–1.89), stage 2 IDH (HR 1.53, 95% CI 1.29–1.82), and stage 2 SDH (HR 1.94, 95% CI 1.71–2.19) showed increased risk of composite cardiovascular disease events. Among young adults with type 2 diabetes, the risks of myocardial infarction, ischemic stroke, heart failure, and CVD-specific mortality increased from stage 1 SDH and higher blood pressure categories. Our findings call attention to the early detection and strict management of hypertension in this population.