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

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 following percutaneous coronary intervention (PCI). Using health check-up data from the Korean National Health Insurance Service (2015–2016), we analyzed 80,187 T2DM patients who underwent PCI. Patients were categorized by blood pressure (BP) levels measured post-PCI: systolic BP < 120 (reference), < 130, <140, < 160, and ≥160 mm Hg; diastolic BP < 80 (reference), < 90, <100, and ≥100 mm Hg. 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% CI) 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 SBP-ESRD association in < 65-year-olds (interaction P = 0.0498). ESRD risk linearly rose with systolic BP and had a J-shaped association with diastolic BP, especially at baseline values of 70 and 68 mm Hg. Elevated BP, including PP, correlated with ESRD risk in a dose‒response manner among T2DM patients who underwent PCI. Strict BP control is crucial for preventing ESRD in this population.