Among Chinese adults with elevated blood pressure, several BP parameters were associated with incident diabetes, with SBP demonstrating the highest predictive performance, suggesting that BP parameters may provide simple supplementary information for diabetes risk stratification in this high-risk population.
In a cohort of 29,377 Chinese adults with elevated blood pressure, 5.28% developed incident diabetes over a median follow-up of approximately 3 years.
Systolic blood pressure (SBP) was significantly associated with incident diabetes after multivariable adjustment.
Diastolic blood pressure (DBP) showed a significant non-linear relationship with incident diabetes, though its linear association was not statistically significant after multivariable adjustment.
Mean arterial pressure (MAP) was significantly associated with incident diabetes.
Pulse pressure (PP) was significantly associated with incident diabetes after multivariable adjustment.
Pulse pressure index (PPI) showed the largest hazard ratio magnitude among all BP parameters for incident diabetes.
The SBP/DBP ratio was significantly associated with incident diabetes and demonstrated a significant non-linear dose-response relationship.
Non-linear dose-response relationships with incident diabetes were identified for four of the six BP parameters examined.
This research suggests that multiple ways of measuring blood pressure can help predict who among people with already-elevated blood pressure is at risk of developing diabetes. The study followed nearly 30,000 adults in China for about three years and found that about 1 in 19 developed diabetes during that time. Several blood pressure measurements — including systolic (the top number), mean arterial pressure, pulse pressure, pulse pressure index, and the ratio of systolic to diastolic pressure — were all linked to higher diabetes risk, even after accounting for other factors that could influence the results. Importantly, the relationship between blood pressure and diabetes risk was not always straightforward. For systolic blood pressure, diastolic blood pressure, mean arterial pressure, and the systolic-to-diastolic ratio, the risk did not increase in a simple straight line — meaning there were threshold effects or inflection points in the dose-response curves. Among all the blood pressure measures tested, systolic blood pressure (the top number most commonly reported) performed best at predicting who would go on to develop diabetes. This research suggests that routine blood pressure readings, which are already collected during standard health check-ups, could serve as a simple, low-cost tool to help identify people at higher risk of developing diabetes — particularly among those who already have elevated blood pressure. The authors note these findings support using blood pressure parameters as supplementary information for diabetes risk stratification in this high-risk population, potentially helping clinicians prioritize preventive interventions without requiring additional testing.
Wu Q, Gao Y, Yu A, Huang Z, Li X. (2026). Multiple blood pressure parameters and risk of incident diabetes in adults with elevated blood pressure: a cohort study with non-linear analyses.. Frontiers in endocrinology. https://doi.org/10.3389/fendo.2026.1887291