Effects of Blood Pressure According to Age on ESRD Development in Patients with Diabetes
AHA Journals: Hypertension: Published on May, 2022
Diabetes is a strong risk factor
for end-stage renal disease (ESRD). Hypertension also plays a crucial role
in the development and progression of kidney failure. Blood pressure (BP)
rises with declining kidney function which in turn aggravates hypertension.
Moreover, as chronic kidney disease
(CKD) worsens, BP becomes more difficult to control, propagating a vicious
cycle of worsening BP and renal function. Therefore, early diagnosis and prompt
treatment of hypertension in high-risk patients are crucial. In addition,
hypertension is common among young people and can cause harmful health effects
even at a young age.
In recent hypertension guidelines,
lower BP targets are recommended for high-risk patients, such as those with
renal disease or diabetes. However, the effects of BP on the development
of ESRD according to age in patients with diabetes have not been investigated.
Therefore, this nationwide population-based study aimed to investigate the association between BP categories according to age and the risk of ESRD among patients with diabetes using the Korean National Health Insurance Service (KNHIS) database.
TAKE-HOME MESSAGE
In this study involving 2,563,870
adults with diabetes (aged 20 years and older) from the Korean
National Health Screening Program, the incidence of end-stage renal disease
(ESRD) increased with increasing systolic (SBP) and diastolic blood pressure
(DBP).
The risk of ESRD development was
highest in patients younger than 40 years with a DBP of 100 mm Hg or
greater. The effects of SBP and DBP on ESRD development were
attenuated with age.
These results suggest that
intensive BP management is crucial in young adults with diabetes to avert the
risk of End-Stage Renal Disease (ESRD). Early detection of persons with hypertension and
treatment with antihypertensive drug therapy are essential as continuing
strategies to prevent ESRD.
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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. 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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