Blood pressure fluctuations are increasingly recognized as a contributor to diabetic kidney disease progression. Data presented at the European Association for the Study of Diabetes Congress 2025 analyzed electronic health records from 3,533 adults with type 1 diabetes across two large university hospitals, including 12% of African-Caribbean heritage. Blood pressure variability was quantified using standard deviation, visit-adjusted standard deviation, average real variability, and variation independent of mean for systolic, diastolic, pulse pressure, and mean arterial pressure.

Over the study period, 214 individuals (6.1%) reached the primary endpoint of kidney function decline, defined as a greater than 50% drop in estimated glomerular filtration rate with final eGFR below 30 ml/min. Higher variability in systolic blood pressure, pulse pressure, and mean arterial pressure significantly predicted kidney disease progression, independent of baseline blood pressure, HbA1c, eGFR, and albuminuria. African-Caribbean heritage remained an independent risk factor (Hazard Ratio 1.65), highlighting the importance of ethnicity in disease trajectory.

These findings suggest that both blood pressure variability and ethnic background are important considerations in managing diabetic kidney disease. Interventions targeting blood pressure stability may help reduce progression in high-risk populations.