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The aim of this study was therefore to determine whether BPV has an impact on kidney disease progression in an ethnically diverse cohort of people with type 1 diabetes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We studied 3079 people (median age 36 [range 18\u201385] years; 50% female; 78.5% White, 10.9% African Caribbean, 4.5% Asian, 6.1% Other) with type 1 diabetes and baseline eGFR &gt;45 ml\/min per 1.73m\n                      <jats:sup>2<\/jats:sup>\n                      attending two university hospital clinics between 2004 and 2018. BPV was assessed using visit-adjusted standard deviation (adj-SD), CV and average real variability (ARV) for systolic blood pressure (SBP) and diastolic blood pressure (DBP). The primary endpoint was eGFR decline of \u226550% from baseline with final eGFR &lt;30 ml\/min per 1.73m\n                      <jats:sup>2<\/jats:sup>\n                      , with death as a competing risk.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Over a 14 year period, 272 people (8.8%) reached the primary endpoint. All BPV metrics for SBP and DBP were significantly associated with the primary endpoint. ARVs of SBP and DBP and African Caribbean ethnicity emerged as risk factors in multivariable analyses, independent of traditional risk factors, including baseline blood pressure, eGFR, HbA\n                      <jats:sub>1c<\/jats:sub>\n                      , albuminuria and mean blood pressure in the exposure window. The strongest association was observed for the ARV of SBP (HR 1.54, 95% CI 1.27, 1.87,\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions\/interpretation<\/jats:title>\n                    <jats:p>In people with type 1 diabetes, SBP and DBP variability are associated with kidney disease progression. Further studies are needed to investigate if BPV is a modifiable risk factor for kidney disease progression.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00125-026-06715-4","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T15:43:23Z","timestamp":1775058203000},"page":"2061-2072","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The impact of blood pressure variability and African Caribbean ethnicity on the progression of diabetic kidney disease in type 1 diabetes"],"prefix":"10.1007","volume":"69","author":[{"given":"Murat","family":"Ozdede","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panagiotis","family":"Pavlou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valson","family":"Krasniqi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kleoniki I.","family":"Athanasiadou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salma","family":"Ayis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Thomas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janaka","family":"Karalliedde","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,1]]},"reference":[{"issue":"6","key":"6715_CR1","doi-asserted-by":"publisher","first-page":"954","DOI":"10.2337\/dc15-0184","volume":"38","author":"AS Krolewski","year":"2015","unstructured":"Krolewski AS (2015) Progressive renal decline: the new paradigm of diabetic nephropathy in type 1 diabetes. 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Data are located in controlled access data storage at King\u2019s College London.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Data availability"}},{"value":"This work was supported by a research grant from Guy\u2019s and St Thomas\u2019 Charity and by a King\u2019s British Heart Foundation (BHF) Centre for Excellence Award (RE\/18\/2\/34213). SA was funded\/supported by the National Institute for Health Research Biomedical Research Centre based at Guy\u2019s and St Thomas\u2019 NHS Foundation Trust and King\u2019s College London. The views expressed are those of the authors and not necessarily those of the National Health Service, the National Institute for Health Research or the Department of Health.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Funding"}},{"value":"JK is a member of the editorial board of\n                      Diabetologia\n                      . The authors declare that there are no other relationships or activities that might bias, or be perceived to bias, their work.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Authors\u2019 relationships and activities"}},{"value":"JK conceived the study. All authors made substantial contributions to the acquisition of data, and developed and designed the methodology and performed the literature investigation. MO, PP and SA performed the statistical analysis. JK, VK, MO, KIA and PP drafted and wrote the manuscript. All authors critically reviewed and edited the manuscript for important intellectual content. JK supervised the study. All authors read and approved the final manuscript. JK and PP are the guarantors of this work and, as such, had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Contribution statement"}}]}}