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.


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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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.


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.


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.


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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This is for informational purposes only. You should consult your clinical textbook for advising your patients.