Multiple blood pressure parameters and risk of incident diabetes in adults with elevated blood pressure: a cohort study with non-linear analyses
This study aimed to compare the strengths of association and predictive performance of systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP), pulse pressure (PP), pulse pressure index (PPI), and the SBP/DBP ratio for incident diabetes among Chinese adults with elevated BP. This retrospective cohort study included 29,377 adults with elevated BP from a large Chinese health examination database. Cox proportional hazards models were used to estimate hazard ratios (HRs), and restricted cubic spline analyses were applied to evaluate non-linear associations. During a median follow-up of 2.98 years, 1,550 participants (5.28%) developed diabetes. After multivariable adjustment, SBP (HR: 1.09, 95% CI 1.05–1.13), MAP (HR 1.07, 95% CI 1.02–1.13), PP (HR 1.06, 95% CI 1.03–1.10), PPI (HR 2.47, 95% CI 1.36–4.46), and the SBP/DBP ratio (HR 1.38, 95% CI 1.13–1.70) were significantly associated with incident diabetes. Restricted cubic spline analyses revealed significant non-linear relationships for SBP, DBP, MAP, and the SBP/DBP ratio. Among all BP parameters, SBP demonstrated the highest predictive performance. Among Chinese adults with elevated BP, several BP parameters were associated with incident diabetes, and significant non-linear dose–response relationships were observed for SBP, DBP, MAP, and the SBP/DBP ratio. SBP showed the highest predictive performance, suggesting that BP parameters may provide simple supplementary information for diabetes risk stratification in this high-risk population.