Association of Systolic and Diastolic Blood Pressure with the Risk of End-Stage Renal Disease in Older Type 2 Diabetes Mellitus Patients without Cardiovascular Disease: A Nationwide Population-Based Study

There is insufficient evidence to determine a precise blood pressure target in older adults with diabetes mellitus. In this study, we evaluated the potential relationship between blood pressure levels and end-stage renal disease (ESRD) in older type 2 diabetes mellitus (T2DM) patients without ESRD using a nationwide longitudinal population dataset. We performed a retrospective, observational, cohort study including 267,156 older (≥65 years old) patients with T2DM and without ESRD from 2009 to 2018 based on the National Health Information Database. We divided the participants into eight groups based on their systolic blood pressure (SBP) and diastolic blood pressure (DBP). The primary outcome was ESRD. All outcomes were analyzed using Cox proportional hazards regression analysis while controlling for baseline covariates. During a median follow-up of 7.26 years, the incidence rate of ESRD was 2.03 per 1,000 person-years. In multivariable Cox proportional hazard modeling, the risk of the primary outcome was the lowest in groups with an SBP of 100-119 mm Hg and DBP of <80 mm Hg. In subgroup analysis according to the use of hypertension medication, there was a significant difference in DBP (P for interaction=0.026) but no difference in SBP (P for interaction=0.247). The risk of ESRD was the lowest in patients with an SBP of 110-129 mm Hg taking hypertension medication and the highest in the group with an SBP of ≥160 mm Hg. Maintaining blood pressure at less than 120/80 mm Hg might prevent progression to ESRD in older T2DM patients without cardiovascular disease.