From the Department of Internal Medicine (E.H.B., T.R.O., S. Hyun Song, S. Heon Suh, H.S.C., C.S.K., S.K.M., S.W.K.), Chonnam National University Medical School, Gwangju, Korea.
Department of Internal Medicine, Korea University Ansan Hospital (S.Y.L.).
Hypertension. 2022 Aug;79(8):1765-1776. doi: 10.1161/HYPERTENSIONAHA.121.18881. Epub 2022 May 24.
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 (interaction 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.
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.
最近的高血压指南建议高危患者的血压（BP）目标更低。然而，目前还没有基于年龄或收缩压和舒张压（分别为 SBP 和 DBP）的具体指南。我们旨在评估与年龄相关的 BP 对糖尿病患者终末期肾病（ESRD）发展的影响。
我们从 2009 年至 2012 年的韩国国家健康筛查计划中选择了年龄>20 岁的 2563870 名糖尿病患者，并进行了随访，直到 2019 年底。参与者被分为年龄和 BP 组，并计算了 ESRD 的风险比。
在中位随访 7.15 年期间，ESRD 的发病率随着 SBP 和 DBP 的升高而增加。年龄<40 岁且 DBP≥100 mm Hg 的患者的 ESRD 风险比最高。SBP 和 DBP 对 ESRD 发展的影响随年龄而减弱（年龄与 SBP 的交互作用<0.0001，年龄与 DBP 的交互作用为 0.0022）。对性别、抗高血压药物和慢性肾脏病史的亚组分析显示，与女性、年龄>40 岁、未服用抗高血压药物和非慢性肾脏病组相比，男性、年龄<40 岁、未服用抗高血压药物和慢性肾脏病组的 ESRD 风险比更高。
较高的 SBP 和 DBP 增加了糖尿病患者发生 ESRD 的风险，尤其是年轻患者面临更大的风险。因此，需要对年轻患者进行强化 BP 管理，以预防 ESRD。
