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.

中文翻译：

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不同年龄的血压对糖尿病患者终末期肾病发展的影响：一项基于全国人群的队列研究

背景：最近的高血压指南建议高危患者降低血压（BP）目标。但是，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。我们旨在评估年龄相关血压对糖尿病患者终末期肾病 (ESRD) 发展的影响。方法：从韩国国家健康筛查中选择了 2 563 870 名年龄 > 20 岁的糖尿病患者。项目从2009年到2012年，随访至2019年底。参与者分为年龄组和血压组，计算ESRD的风险比。结果：在中位随访7.15年期间，ESRD发病率增加随着 SBP 和 DBP 的增加。年龄小于 40 岁且 DBP≥100 mm Hg 的患者 ESRD 的风险比最高。SBP 和 DBP 对 ESRD 发展的影响随着年龄的增长而减弱（相互作用年龄和 SBP 的P < 0.0001，年龄和 DBP 的 P < 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 40 岁以上服用抗高血压药物的女性相比，40 岁以下未服用抗高血压药物和慢性肾脏病的男性患 ESRD 的风险比更高和非慢性肾病组。结论：较高的 SBP 和 DBP 会增加糖尿病患者发生 ESRD 的风险，尤其是年轻人面临更大的风险。因此，需要对年轻患者进行强化血压管理以预防 ESRD。