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

OBJECTIVE The impact of young-onset hypertension (YOH) on cardiovascular and kidney outcomes in people with type 2 diabetes (T2D) has not been systematically studied. RESEARCH DESIGN AND METHODS 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 YOH as hypertension presenting at age <45 years. Individuals with YOH and late-onset hypertension (LOH) were compared with individuals with T2D without hypertension matched for age, sex, diabetes duration, and calendar year. Cox regression was conducted to derive hazard ratios (HRs) and 95% CIs for cardiovascular disease, chronic kidney disease, end-stage kidney disease, and all-cause death in YOH and LOH groups compared with their respective matched control groups. Risk modification by sex was explored in a subgroup analysis. RESULTS A total of 19,224 individuals with YOH and 57,795 individuals with LOH were matched with respective control individuals. YOH was associated with a greater increase in risks for cardiovascular disease (HR 1.83 [95% CI 1.65, 2.03] vs. 1.43 [1.36, 1.5] for LOH), chronic kidney disease (2.58 [2.38, 2.8] vs. 1.81 [1.75, 1.88] for LOH), congestive heart failure (2.58 [1.92, 3.47] vs. 1.81 [1.61, 2.03] for LOH), and death (1.37 [1.22, 1.54] vs. 1.31 [1.25, 1.37] for LOH) (P 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 for three-way interaction < 0.05). CONCLUSIONS YOH conferred greater risks of cardiovascular and kidney outcomes than LOH in T2D.