Cumulative blood pressure load as a predictor of arterial stiffness progression and incident diabetic kidney disease: a multicenter longitudinal study
Authors' conclusion
Cumulative BP load is an effective indicator for predicting the progression of arterial stiffness and incidence of DKD, with the best predictive performance observed when the target SBP is set at < 120 mmHg.
Study context
- Population
- Participants with T2D from 10 diabetes centres; mean age 54.5 years, 57.5% male
- Participants
- 18,168 participants
- Exposure
- Cumulative blood pressure (BP) load calculated with SBP targets <120 vs <130 vs <140 mmHg
- Outcome
- Progression of arterial stiffness (ba-PWV changes) and incidence of DKD (eGFR < 60 mL/min/1.73m2 or urine albumin-to-creatinine ratio ≥ 3.39 mg/mmol); predictive ability by adjusted R2 and NRI
- Follow-up
- Mean 3.5 years
Methodological details10 diabetes centres
- 10 diabetes centres
Main finding
As reported in the abstract
Predictive ability of cumulative BP load added to traditional risk factors
| Group | Adjusted R2, annual change in brachial-ankle pulse wave velocity (ba-PWV) | Net reclassification improvement (NRI), diabetic kidney disease (DKD) incidence |
|---|---|---|
| SBP < 120 mmHg | 0.193 (95% CI 0.180-0.200) | 15.8% (11.5-20.0%) |
| SBP < 130 mmHg | 0.184 (0.169-0.191) | 12.5% (8.3-16.7%) |
| SBP < 140 mmHg | 0.172 (0.158-0.180) | 6.4% (2.3-10.6%) |
Adjusted R2, annual change in brachial-ankle pulse wave velocity (ba-PWV)
SBP < 120 mmHg0.193 (95% CI 0.180-0.200)
SBP < 130 mmHg0.184 (0.169-0.191)
SBP < 140 mmHg0.172 (0.158-0.180)
Net reclassification improvement (NRI), diabetic kidney disease (DKD) incidence
SBP < 120 mmHg15.8% (11.5-20.0%)
SBP < 130 mmHg12.5% (8.3-16.7%)
SBP < 140 mmHg6.4% (2.3-10.6%)
Observational data: associations, not effects.
Further findings
Outcome occurrence in the cohort · mean follow-up 3.5 years
- Median ba-PWV increase
- 0.19 m/s per year
- Developed DKD
- 2,855 (25.6%)
Original publication
Cumulative blood pressure load as a predictor of arterial stiffness progression and incident diabetic kidney disease: a multicenter longitudinal study. Cardiovasc Diabetol. Published 24 May 2025. doi:10.
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