The relationship between blood pressure and the risks of cardiovascular disease, kidney disease, and death across different age groups among individuals with type 2 diabetes

Summary:
Blood pressure changes with age, with systolic levels steadily increasing and diastolic levels rising earlier before declining later in life. A large cohort study of over 429,000 individuals with type 2 diabetes found that higher blood pressure is linked to increased risks of cardiovascular disease, kidney disease, and death, with these associations varying by age. The impact of elevated systolic blood pressure was significantly stronger in younger individuals compared to older groups. Overall, the findings highlight that high blood pressure poses a greater risk in younger people with type 2 diabetes, emphasizing the need for early and effective management. 

Blood pressure (BP) varies across the lifespan: systolic BP (SBP) tends to rise continuously with age, whereas diastolic BP (DBP) increases earlier in life and then decreases after midlife. While high BP is known to be associated with cardiovascular and kidney-related complications, how these relationships differ by age in people with type 2 diabetes (T2D) is not yet clearly understood.

A population-based cohort study explored age-specific associations between SBP, DBP, and the risks of cardiovascular disease (CVD), kidney disease, and overall mortality in individuals with T2D. The analysis included 429,740 participants with T2D who were enrolled in the RAMP-DM program in Hong Kong from 2000 to 2022. Baseline information on demographic characteristics, lifestyle factors, and clinical measures was obtained. Outcomes assessed were new-onset CVD (including stroke, coronary heart disease, and peripheral artery disease), chronic kidney disease (CKD), kidney failure, and death from any cause during a median follow-up period of 8.6 years.

Younger participants (18–44 years) had a higher proportion of males (56.9%) and smokers (23.3%), whereas older groups exhibited a greater prevalence of hypertension and more frequent use of BP-lowering medications. During follow-up, 37,382 CVD events occurred. Among younger individuals, each 10 mmHg increase in SBP was linked to significantly higher risks: 16% for CVD, 17% for CKD, 19% for kidney failure, and 14% for mortality. In contrast, for those aged 75 years and older, the corresponding increases were notably smaller—5%, 5%, 9%, and 2%, respectively. These results indicate a clear trend, with stronger associations between elevated SBP and adverse outcomes in younger individuals compared with older age groups.

Overall, the findings suggest that elevated BP has a more pronounced impact on cardiovascular, renal, and mortality outcomes in younger people with T2D, underscoring the importance of early and effective BP management in this population.