Uncontrolled hypertension is associated with an increased risk of end-stage renal disease in patients with type 2 diabetes who underwent postpercutaneous coronary intervention: A nationwide population-based study

Background Little is known about the use of hypertension to predict end-stage renal disease (ESRD) in patients with type 2 diabetes mellitus (T2DM) and established coronary artery disease who underwent percutaneous coronary intervention (PCI). Here, we evaluated the effect of differential blood pressure (BP) levels on future ESRD in this population. Methods Using nationwide health check-up data from the Korean National Health Insurance Service between 2015 and 2016, we obtained data for 80,187 patients with T2DM who underwent previous PCI. Patients were classified into four groups according to BP level measured within at least 2 years after PCI: systolic BP <120 (reference), <130, <140, <160, and ≥160 mm Hg; diastolic BP <80 (reference), <90, <100, and ≥100 mm Hg. The primary outcome was incident ESRD, defined as a combination of the relevant disease code and the initiation of renal replacement therapy. Multivariate Cox proportional hazard regression analysis was used to estimate the adjusted hazard ratio (HR) (95% CI) according to BP group. Results The mean age was 67.7 years, and 80.9% of the participants were treated with antihypertensive medication. ESRD occurred in 1,362 (1.70%) patients during the 4.7-year follow-up. After adjustment for confounding factors, the HR of ESRD patients significantly and sequentially increased in the higher BP groups. Similar findings were noted regarding the relationship between incident ESRD and pulse pressure (PP). According to the subgroup analysis, this relationship was more significant for SBP in those aged <65 years than in those who were aged 65 years or older ( P for interaction=0.0498). ESRD risk was linearly associated with systolic BP and had a J-shaped association with diastolic BP in patients with baseline values of 70 and 68 mm Hg. Conclusions In this nationwide population-based study, elevated systolic and diastolic BP and PP were associated with the risk of developing ESRD in a dose‒response manner among T2DM patients who underwent PCI. To prevent ESRD, more strict BP control is needed in T2DM patients who underwent PCI.