Investigating the Relationship between Uncontrolled Blood Pressure and Progression of Diabetic Neuropathy in Patients with Type 2 Diabetes Mellitus
Abstract
Diabetic nephropathy (DN) is a leading cause of end-stage renal disease (ESRD) globally, predominantly affecting individuals with type 2 diabetes mellitus (T2DM). Uncontrolled blood pressure (UBP) is a well-established risk factor that accelerates the progression of renal complications in diabetic patients. However, the extent of this association remains inadequately characterized in real-world clinical settings. This retrospective study aimed to investigate the correlation between sustained elevations in blood pressure and the onset and progression of diabetic nephropathy in patients diagnosed with T2DM. The clinical records of patients with T2DM were reviewed over a 5-year period. Patients were stratified into controlled and uncontrolled blood pressure groups on the basis of American Diabetes Association (ADA) guidelines. The presence and severity of diabetic nephropathy were assessed through the estimated glomerular filtration rate (eGFR), the albumin-to-creatinine ratio (ACR), and serum creatinine levels. Statistical analyses, including logistic regression and Kaplan‒Meier survival estimates, were employed to determine the strength and nature of associations. Among the most eligible T2DM patients, those with uncontrolled blood pressure demonstrated a significantly greater prevalence of microalbuminuria (p < 0.001), a faster decline in the eGFR (p = 0.002), and earlier onset of overt nephropathy than their normotensive counterparts did. After adjusting for age, sex, BMI, and glycemic control, UBP remained an independent predictor of nephropathy progression (OR: 2.78, 95% CI: 1.96–3.94). This study underscores the critical role of blood pressure management in mitigating renal complications among T2DM patients. Proactive control of hypertension may serve as a modifiable risk factor to delay or prevent the onset of diabetic nephropathy, reinforcing the need for integrated care approaches in diabetes management.
