Higher blood pressure severity in adults with type 2 diabetes was associated with increased albuminuria and poorer glycaemic control, which declined from 61.5% in normal BP to 47.9% in severe BP.
Cross-Sectional (n=32,046)
In a large real-world cohort of adults with type 2 diabetes, nearly two-thirds had elevated or hypertensive blood pressure according to AHA 2025 categories, and cardio-kidney-metabolic target attainment was suboptimal across all groups.
Objective: Hypertension and cardio–kidney–metabolic abnormalities frequently coexist in type 2 diabetes mellitus, contributing to substantial cardiovascular and renal risk. Contemporary data describing the distribution of AHA 2025 blood pressure categories and associated CKM target attainment in large real-world diabetes populations remain limited.Design and method: We performed a cross-sectional study of adults with T2DM attending a large regional diabetes programme in 2024. BP was classified using AHA 2025 definitions: normal, mild, moderate, and severe. A hybrid outlier strategy was applied: physiologic limits (SBP 260 mmHg; DBP 150 mmHg) followed by group-specific ±3 SD trimming. Patients with missing BP were retained but excluded from BP-group analyses. CKM target attainment included BMI 3.5, and HbA1c 3.5 mg/mmol) increased markedly with BP severity, while glycaemic control (HbA1c < 7%) declined from 61.5% to 47.9%. Achievement of LDL-C < 1.8 mmol/L remained modest (43–47%) and BMI < 25 kg/m2 was uncommon (12–17%) across all groups. Prescribing patterns varied across BP categories. SGLT2 inhibitor use was consistently high (62–65%) irrespective of BP. In contrast, GLP-1 receptor agonist use was highest in the normal BP group (44.1%) and declined with increasing BP severity to 26.6%. Use of RAS inhibitors increased substantially with BP severity (33.7% to 69.4%), and finerenone use also rose (2.5% to 5.6%), paralleling greater hypertension and kidney disease burden. Conclusions: In this large T2DM cohort, nearly two-thirds met criteria for elevated or hypertensive BP categories, with severe hypertension associated with older age, higher albuminuria, and poorer glycaemic control. CKM target attainment was suboptimal across all categories. These findings highlight a major opportunity to intensify integrated BP, metabolic, and renal risk reduction strategies in high-risk diabetes populations.
Ahmed et al. (2026) conducted a cross-sectional in Type 2 diabetes mellitus (n=32,046). AHA 2025 blood pressure categories vs. Normal blood pressure was evaluated on Cardio-kidney-metabolic (CKM) target attainment (BMI <25 kg/m2, LDL <1.8 mmol/L, urinary ACR >3.5, and HbA1c <7%). Higher blood pressure severity in adults with type 2 diabetes was associated with increased albuminuria and poorer glycaemic control, which declined from 61.5% in normal BP to 47.9% in severe BP.