A real-world study published in Diabetes, Obesity and Metabolism, including more than 180,000 elderly patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD), systematically analyzed the relationships between blood pressure levels, missing blood pressure recordings, cardiovascular outcomes, and all-cause mortality.
Using the UK Clinical Practice Research Datalink (CPRD), the study established the largest real-world cohort in this field to date. A total of 181,307 patients aged ≥65 years with T2DM and CKD stages 3–5, diagnosed in primary care settings between 2000 and 2023, were enrolled, among whom 160,764 met the criteria for major adverse cardiovascular event (MACE) analysis. The cohort was constructed using a strict dual-diagnosis confirmation process, with the index date defined as the later diagnosis date of T2DM or CKD, and follow-up continued until June 2023.
During follow-up, 23,260 patients (14.5%) developed MACE and 43,853 patients (24.2%) died. Among the analyzed population, only approximately one-quarter of patients had complete blood pressure recordings within 2 years at baseline (27.4% in the MACE cohort and 24.7% in the mortality cohort), indicating a high prevalence of missing blood pressure monitoring in real-world clinical practice.
The most important finding emerged from the group with missing blood pressure recordings.The 5-year MACE risk was 14.1% in patients with normal blood pressure, 13.8% in those with elevated blood pressure, and 19.6% in those with missing blood pressure recordings.For 5-year all-cause mortality, the risk was 20.6% in patients with normal blood pressure, 19.4% in those with elevated blood pressure, and 34.0% in those with missing blood pressure recordings.
In other words, patients without regular blood pressure monitoring had an approximately 65% higher mortality risk than those with normal blood pressure, and this risk was significantly higher than that associated with elevated blood pressure alone. These associations remained robust after multivariable adjustment and sex-stratified analyses, suggesting that missing blood pressure recordings are an extremely strong and independent poor prognostic indicator.
This study further supports existing evidence that insufficient blood pressure monitoring is closely linked to poor clinical outcomes. Patients with missing blood pressure recordings had significantly higher risks of MACE and all-cause mortality, implying that inadequate monitoring may reflect weak disease management, barriers to healthcare access, poor follow-up adherence, or disengagement from continuous care systems. The category of missing blood pressure may also comprehensively reflect a broader risk background, including frailty, cognitive impairment, and social vulnerability.
Although more than 90% of patients with missing blood pressure recordings were receiving cardiovascular medications at baseline, the absence of blood pressure measurements within 2 years after diagnosis still exposed systematic deficiencies in risk assessment and chronic disease management, or persistent non-adherence of patients to routine care.