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We studied the age-specific associations between BP and incident cardiovascular disease(CVD), chronic kidney disease(CKD), kidney failure, and all-cause death among individuals with T2D.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We included individuals with T2D who underwent structured diabetes assessment between 2000 and 2022 in Hong Kong Special Administrative Region, People's Republic of China. Participants were stratified by baseline age(18\u201344\u00a0years, 45\u201359\u00a0years, 60\u201374\u00a0years, and 75\u00a0years or older). Cox proportional hazard model was used to estimate hazard ratios for the risk of incident CVD, CKD, kidney failure and all-cause death associated with systolic blood pressure(SBP) and diastolic blood pressure(DBP) categories, referenced to SBP 120\u2013129\u00a0mmHg and DBP 70\u201379\u00a0mmHg within each age stratum. Non-linear association between SBP\/ DBP and clinical outcomes was modelled using restricted cubic splines(RCS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We included 429,740 individuals with T2D (mean age 61.9\u00a0years, 52.7% men, 75.3% pre-existing hypertension). SBP above 120\u2013129\u00a0mmHg and DBP above 70\u201379\u00a0mmHg were associated with a proportional increase in risks for CVD, CKD, kidney failure and death across ages adjusted for demographics, diabetes duration, BMI, smoking status, HbA1c, lipids, albuminuria, history of CVD, CKD and use of BP-lowering medications. The strength of the risk associations was greatest in youngest age group and declined with increasing age. Among individual components of CVD, risks conferred by an incremental increase in SBP or DBP were high for hemorrhagic stroke. A 10\u00a0mmHg or 1-SD increase in SBP \/ DBP conferred a 1.2 to 1.5-fold increase in hazards for hemorrhagic stroke among individuals aged 18\u201344\u00a0years (\n                      <jats:italic>p<\/jats:italic>\n                      -interaction &lt;\u20090.001). RCS indicated variable linear and nonlinear associations between SBP\/DBP and CVD, kidney disease, or death across age categories.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We observed heterogeneity in the relationship between BP and various clinical outcomes across ages in a diabetes population. Risk associations were strongest among young individuals, emphasising the importance of BP management in this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1186\/s12933-025-03072-1","type":"journal-article","created":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T10:24:43Z","timestamp":1769595883000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Age-specific associations between blood pressure and cardiovascular disease, kidney disease, and death among individuals with type 2 diabetes: a population-based cohort study"],"prefix":"10.1186","volume":"25","author":[{"given":"Edith W. 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Ethics approval was obtained from the Joint-Chinese University of Hong Kong-New territories East Cluster Clinical Research Ethics Committee. The need for informed consent was waived, given the retrospective nature of the study and the use of anonymised clinical data.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"JC has received research grants through her affiliated institutions and\/or honoraria for consultancy or giving lectures from Applied Therapeutics, AstraZeneca, Bayer, Boehringer Ingelheim, Celltrion, Eli-Lilly, Hua Medicine, Merck, Merck Sharp & Dohme, Novo Nordisk, Novartis, Pfizer, Servier, Sanofi, Viatris and ZP Therapeutics. AK has received research grants and\/or speaker honoraria from Abbott, Astra Zeneca, Bayer, Biomea Fusion Inc, Boehringer Ingelheim, Dexcom, Eli-Lilly, Kyowa Kirin, Merck Serono, Merck Sharp & Dohme, Nestle, Novo Nordisk, Pfizer, Sanofi and Zuellig Pharma. RCWM reported receiving grants and\/or honoraria for consultancy or giving lectures from AstraZeneca, Bayer, Boehringer Ingelheim, Eli Lilly, Pfizer, and Takeda. AL reported receiving grants and\/or honoraria for consultancy or giving lectures from Amgen, AstraZeneca, Boehringer Ingelheim, Merck Sharp & Dohme, Novartis, Novo Nordisk, and Sanofi. EC has received institutional research support and\/or honoraria for giving lectures for Sanofi, Novartis, Medtronic Diabetes, Powder Pharmaceuticals Inc. The proceeds have been donated to The Chinese University of Hong Kong, American Diabetes Association and other charity organizations to support diabetes research and education. EWK has received travel sponsorship by Boehringer Ingelheim and Novo Nordisk. The remaining authors report no potential conflict of interest.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"60"}}