Abstract Body: Introduction: Contemporary clinical practice guidelines have intensified blood pressure (BP) targets for people with diabetes. This study aimed to assess the population impact (e.g., the proportion and number of people requiring BP reduction) of these guideline changes in South Korea.
Methods: We analyzed nationally representative data from the 2013–2021 Korea National Health and Nutrition Examination Survey. Three guideline BP targets for diabetes were studied: (1) 2018 Korean Society of Hypertension (KSH); (2) 2022 KSH, the current guideline; and (3) universal target of <130/80 mm Hg, as in the ACC/AHA guidelines (Figure A). The proportion and number of people with diabetes and those with BP above each guideline target (i.e., requiring BP reduction) were calculated using survey weights and Korean population estimates.
Results: The study sample included 52,988 participants aged 20 years or older, representing 41,945,333 adults in South Korea. The crude prevalence of diabetes was 12.0% (95% CI, 11.7-12.4), corresponding to 5,679,365 adults. Among them, a lower BP target of <130/80 mm Hg was indicated in 98.7% classified as high-risk diabetes according to the 2022 KSH guideline, or 5.9% with prior coronary heart disease according to the 2018 KSH guideline. The proportion of adults with diabetes and BP above the guideline target was 51.2% (95% CI, 49.5-52.9) according to the 2022 KSH guideline versus 30.8% (95% CI, 29.2-32.4) according to the 2018 KSH guideline (difference: +20.4%p, 1,157,592 individuals; Figure B). When a universal target of <130/80 mm Hg was applied regardless of risk stratification, the proportion above the target was 51.5% (95% CI, 49.7-53.2), with a minimal difference of +0.3%p (16,807 individuals), compared with the 2022 KSH target. The concordance/discordance between the guideline targets is depicted in Figure C. Findings were similar across study years, sex, age groups, antihypertensive treatment, and comorbidities.
Conclusion: Compared with the 2018 KSH guideline, the 2022 KSH guideline resulted in a substantial increase in the number requiring BP reduction among Korean adults with diabetes. A universal target of <130/80 mm Hg would yield only a minimal increase in the number requiring BP reduction compared with the 2022 KSH target.