Key result
Higher systolic and diastolic blood pressure increased the risk of end-stage renal disease in patients with diabetes, with the effect significantly greater in younger patients (interaction P<0.0001 for age and SBP).
Why the study?
Recent hypertension guidelines recommend lower blood pressure targets in high-risk patients, but specific guidance based on age or systolic and diastolic blood pressure is lacking.
Does higher blood pressure increase the risk of developing end-stage renal disease in patients with diabetes, and does this effect vary by age?
Cohort (n=2,563,870)
Yes
Does higher blood pressure increase the risk of developing end-stage renal disease in patients with diabetes, and does this effect vary by age?
Answers are grounded in this paper and cite their sources.
Higher blood pressure significantly increases the risk of end-stage renal disease in patients with diabetes, with the greatest relative risk observed in younger patients (<40 years).
Background: Recent hypertension guidelines have recommended lower blood pressure (BP) targets in high-risk patients. However, there are no specific guidelines based on age or systolic and diastolic blood pressure (SBP and DBP, respectively). We aimed to assess the effects of age-related BP on development of end-stage renal disease (ESRD) in patients with diabetes. Methods: A total of 2 563 870 patients with diabetes aged >20 years were selected from the Korean National Health Screening Program from 2009 to 2012 and followed up until the end of 2019. Participants were categorized into age and BP groups, and the hazard ratios for ESRD were calculated. Results: During a median follow-up of 7.15 years, the incidence rates of ESRD increased with increasing SBP and DBP. The hazard ratio for ESRD was the highest in patients younger than 40 years of age with DBP≥100 mm Hg. The effect of SBP and DBP on ESRD development was attenuated with age (interaction P was <0.0001 for age and SBP, and 0.0022 for age and DBP). The subgroup analysis for sex, antihypertension medication, and history of chronic kidney disease showed higher hazard ratios for ESRD among males, younger than 40 years, not taking antihypertension medications and chronic kidney disease compared to those among females, older than 40 years, antihypertension medication, and nonchronic kidney disease groups. Conclusions: Higher SBP and DBP increase the risk of developing ESRD in patients with diabetes, and in particular, younger individuals face greater risk. Therefore, intensive BP management is warranted in younger patients to prevent ESRD.
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Bae et al. (2022) conducted a cohort in Diabetes (n=2,563,870). Higher systolic and diastolic blood pressure vs. Lower blood pressure was evaluated on End-stage renal disease (ESRD). Higher systolic and diastolic blood pressure increased the risk of end-stage renal disease in patients with diabetes, with the effect significantly greater in younger patients (interaction P<0.0001 for age and SBP).
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