Abstract
We investigated the effect of differential blood pressure (BP) levels on future end-stage renal disease (ESRD) in patients with type 2 diabetes mellitus (T2DM) and established coronary artery disease with a previous record of percutaneous coronary intervention (PCI). Using health check-up data from the Korean National Health Insurance Service (2015-2016), we analyzed 80,187 T2DM patients with a history of PCI. Patients were categorized by BP levels measured: systolic BP < 120, 120-129 (reference), 130-139, 140-149, and ≥150 mmHg; diastolic BP < 70, 70-79 (reference), 80-89, and ≥90 mmHg. Incident ESRD, defined by disease codes and renal replacement therapy initiation, was the primary outcome. Multivariate Cox proportional hazard regression assessed adjusted hazard ratios (HRs) (95% confidence intervals) by BP group. Mean age was 67.7 years; 80.9% used antihypertensives. ESRD incidence was 1.70% (1,362 patients) over 4.7 years. After adjustment for confounding factors, the HR of ESRD patients significantly and sequentially increased in the higher BP groups. Similar trends were seen with pulse pressure (PP). Subgroup analysis showed stronger BP-ESRD association in < 65-year-olds compared to those aged ≥65 years. ESRD risk linearly increased with systolic BP and had a J-shaped association with diastolic BP, with the lowest risk at 68 mmHg. Elevated BP, including PP, correlated with ESRD risk in a dose‒response manner among T2DM patients with a previous record of PCI. Strict BP control is crucial for preventing ESRD in these high-risk patients.