TOPLINE:

In patients with type 2 diabetes (T2D), both young-onset hypertension (onset before the age of 45 years) and late-onset hypertension (onset at the age of 45 years or later) were associated with higher risks for cardiovascular disease (CVD), congestive heart failure, chronic kidney disease, and all-cause mortality, with young-onset hypertension linked to poorer outcomes.

METHODOLOGY:

• The onset of hypertension at a young age increases the lifetime risk for end-organ damage due to prolonged high blood pressure, even with treatment; however, its specific effects on cardiovascular and kidney outcomes in patients with T2D are not well characterized.
• Researchers conducted a retrospective cohort study to evaluate the impact of young-onset hypertension on the progression of CVD, kidney disease, and all-cause mortality in patients with T2D.
• The study included 19,224 patients with T2D and young-onset hypertension (mean age at onset, 38.17 years; 45.6% women), 57,795 with late-onset hypertension (mean age at onset, 55.28 years; 48.6% women), and an equal number of patients with T2D without hypertension in corresponding matched control groups.
• The median follow-up duration was approximately 7.9 years for the young-onset hypertension group and approximately 7.3 years for the late-onset hypertension group.
• Study outcomes included the incidence of CVD (such as stroke, coronary artery disease, and peripheral artery disease), chronic kidney disease, end-stage kidney disease, congestive heart failure, and all-cause mortality during follow-up.

TAKEAWAY:

• Compared with no hypertension, young-onset hypertension was significantly associated with increased risks for CVD (adjusted hazard ratio [aHR], 1.83), congestive heart failure (aHR, 2.58), chronic kidney disease (aHR, 2.58), end-stage kidney disease (aHR, 4.28), and all-cause mortality (aHR, 1.37).
• Late-onset hypertension was also associated with increased risks for CVD (aHR, 1.43), congestive heart failure (aHR, 1.81), chronic kidney disease (aHR, 1.81), and all-cause death (aHR, 1.31) but to a lesser extent than young-onset hypertension.
• The excess risks associated with young-onset vs late-onset hypertension were significantly greater for coronary heart disease, ischemic stroke, and hemorrhagic stroke but not for peripheral artery disease.
• The excess risks for cardiovascular and coronary heart disease associated with young-onset hypertension were significantly greater in women than in men (P for interaction < .05 for both).

IN PRACTICE:

“Our results highlight the clinical burden of young individuals with T2D and comorbid hypertension, underscoring the importance of developing interventions specifically tailored to this population,” the authors wrote.

SOURCE:

This study was led by Edith W.K. Chow, The Chinese University of Hong Kong, Hong Kong, People’s Republic of China. It was published online in Diabetes Care.

LIMITATIONS:

This study relied on self-reported age of hypertension onset, which may have introduced recall bias. The use of propensity score matching may have introduced selection bias and reduced the representativeness of the original cohort. Additionally, the study cohort consisting mainly of individuals of Chinese ethnicity limited generalizability to other populations.

DISCLOSURES:

This study was partly supported by the Research Grants Council of the Hong Kong Special Administrative Region, People’s Republic of China. Some authors reported receiving research grants, honoraria, research support, or travel sponsorship from various pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.