Association of morning home systolic blood pressure and albuminuria with cardiovascular events in Japanese patients with type 2 diabetes mellitus: The KAMOGAWA-HBP study

Circadian blood pressure abnormalities and albuminuria are established cardiovascular (CV) risk factors in patients with type 2 diabetes mellitus (T2DM); however, the clinical significance of their combined assessment remains unclear. We investigated the combined impact of morning home systolic blood pressure (mHSBP) and urinary albumin-to-creatinine ratio (UACR) on CV events in 1,031 patients from the KAMOGAWA-HBP study after excluding those with prior CV or cerebrovascular disease or missing data. Home blood pressure was measured over 14 days, and UACR was assessed from three samples. The primary endpoint was the first occurrence of composite CV events. In multivariable Cox proportional hazards models adjusted for conventional risk factors, CV risk increased across higher categories of mHSBP and albuminuria. In patients with UACR < 30 mg/gCr, higher mHSBP showed a non-significant trend toward increased risk, whereas in those with UACR ≥ 30 mg/gCr, mHSBP ≥140 mmHg was associated with increased CV risk (hazard ratio 2.15, 95% confidence interval 1.05–4.40). No significant interaction between mHSBP and UACR was observed, and sex-stratified analyses showed similar overall patterns without significant interaction. Elevated mHSBP and albuminuria were independently associated with increased CV risk in patients with T2DM. Although no significant interaction was observed, assessment of both factors may provide additional information for CV risk stratification.