TOPLINE:

Missing blood pressure (BP) records within 2 years prior to diagnosis were associated with substantially higher risks for major adverse cardiovascular events (MACEs) and all-cause mortality in older adults with type 2 diabetes (T2D) and chronic kidney disease (CKD). Among those with recorded BP, systolic BP of 120 mm Hg conferred a moderately higher risk for mortality outcomes than that of 140 mm Hg.

METHODOLOGY:

• Researchers in England investigated associations between baseline systolic and diastolic BP and the risk for MACEs and all‑cause mortality in adults aged 65 years or older with T2D and CKD (stages 3-5) and assessed the influence of missing BP records (used as a proxy for poor monitoring) on those outcomes.
• They analysed data of 181,307 individuals for all‑cause mortality and 160,764 individuals for MACE outcomes, with follow‑up beginning in January 2000 and continuing until the earliest of the first MACE event, death, transfer out of the GP practice, last GP record update, or the data cutoff (June 2023).
• Baseline BP was the measurement nearest to cohort entry within the 2 years prior to dual diagnosis and was categorised as high (≥ 140/90 mm Hg), normal (< 140/90 mm Hg), or missing if no BP record existed in that 2‑year window.
• Primary outcomes were 3-point MACEs (non-fatal stroke, non-fatal myocardial infarction, and cardiovascular death) and all-cause mortality.

TAKEAWAY:

• Among 46,579 individuals with complete data on continuous systolic BP, the unadjusted 5‑year risk for MACEs was similar between those with systolic BP of 120 and 140 mm Hg (14.8% vs 13.8%); however, when BP was categorised across all 160,764 individuals, those with missing systolic BP had a higher unadjusted risk for MACEs than those with normal systolic BP (19.6% vs 14.1%).
• Among 47,374 individuals with complete data on systolic BP, the unadjusted 5‑year risk for mortality was slightly higher for those with systolic BP of 120 mm Hg than for those with systolic BP of 140 mm Hg (21.9% vs 19.7%); when including all 181,307 individuals, those with missing systolic BP had a higher unadjusted 5‑year risk for mortality than those with normal systolic BP (34.0% vs 20.6%).
• Men had higher risks for both MACEs and all‑cause mortality than women across BP comparisons.

IN PRACTICE:

"[The study] findings emphasise the need for routine BP assessments and personalised treatment strategies to optimise cardiovascular outcomes in this vulnerable population," the authors wrote.

SOURCE:

This study was led by Anna Meffen, PhD, Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, England. It was published online on October 28, 2025, in Diabetes, Obesity and Metabolism.

LIMITATIONS:

Because this was an observational study, residual confounding could not be eliminated. Key variables, including other comorbidities, detailed antihypertensive treatment data, and albumin‑to‑creatinine ratio, were incompletely recorded or missing, potentially biasing the observed associations. BP was measured only at a single baseline timepoint, so visit‑to‑visit variability over time was not captured.

DISCLOSURES:

This study was supported by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration East Midlands, the Leicester NIHR Biomedical Research Centre, and the British Heart Foundation Research Excellence Award. Two authors reported receiving consulting fees, speaker fees, or grants from multiple pharmaceutical companies.

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