Young-onset hypertension confers higher risk of cardiovascular disease, kidney disease, and all-cause mortality in individuals with type 2 diabetes: a propensity score matched cohort analysis

<p dir="ltr">Objective: </p><p dir="ltr">The impact of young-onset hypertension(YOH) on cardiovascular and kidney outcomes in people with type 2 diabetes(T2D) has not been systematically studied.</p><p><br></p><p dir="ltr">Research Design and Methods:</p><p dir="ltr">This is a retrospective cohort study. We identified individuals with T2D and hypertension who underwent diabetes assessment between 2010 and 2024 in Hong Kong. We defined young-onset hypertension(YOH) as hypertension presenting below age 45. Individuals with YOH and late-onset hypertension(LOH) were compared to individuals with T2D without hypertension matched for age, sex, diabetes duration and calendar year. Cox regression was conducted to derive hazard ratios(HRs, 95% C.I) for cardiovascular disease, chronic kidney disease, end-stage kidney disease, and all-cause death in YOH and LOH groups, compared to their respective matched controls. Risk modification by sex was explored in subgroup analysis.</p><p><br></p><p dir="ltr">Results: 19,224 individuals with YOH and 57,795 individuals with LOH were matched to respective controls. YOH was associated with a greater increase in risks for cardiovascular disease(HR 1.83[1.65, 2.03] vs.HR 1.43[1.36, 1.5] for LOH), chronic kidney disease(HR 2.58[2.38, 2.8] vs. 1.81[1.75, 1.88] for LOH), congestive heart failure(HR 2.58[1.92, 3.47] vs. 1.81[1.61,2.03] for LOH), and death(HR 1.37[1.22, 1.54] vs. HR 1.31[1.25, 1.37] for LOH, p-value for interaction <0.01). Differences in excess risks between YOH and LOH were more pronounced in women than men for cardiovascular disease and coronary heart disease (p-value for three-way interaction<0.05). </p><p><br></p><p dir="ltr">Conclusion: YOH conferred greater risks of cardiovascular and kidney outcomes than LOH in T2D. </p>