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. 2022 Aug;79(8):1765-1776.
doi: 10.1161/HYPERTENSIONAHA.121.18881. Epub 2022 May 24.

Effects of Blood Pressure According to Age on End-Stage Renal Disease Development in Patients With Diabetes: A Nationwide Population-Based Cohort Study

Eun Hui Bae  1 , Sang Yeob Lim  2 , Bongseong Kim  3 , Tae Ryom Oh  1 , Su Hyun Song  1 , Sang Heon Suh  1 , Hong Sang Choi  1 , Eun Mi Yang  4 , Chang Seong Kim  1 , Seong Kwon Ma  1 , Kyung-Do Han #  3 , Soo Wan Kim #  1
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Effects of Blood Pressure According to Age on End-Stage Renal Disease Development in Patients With Diabetes: A Nationwide Population-Based Cohort Study

Eun Hui Bae et al. Hypertension. 2022 Aug.

Abstract

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.

Keywords: blood pressure; cardiovascular diseases; hypertension; kidney diseases; young adult.

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Figures

Figure.
Figure.
Incidence rate (IR) and hazard ratios (HR) for end-stage renal disease according to blood pressure group with age. Systolic blood pressure (A) and diastolic blood pressure (B). Adjusted for age, sex, income-low 25%, current smoker, alcohol consumption, regular exercise, hypertension, dyslipidemia, chronic kidney disease, diabetes duration ≥5 y, insulin, oral hypoglycemic agents ≥3.
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