Objective:

To evaluate the association of diastolic blood pressure variability (DBPV) with renal progression in diabetic kidney disease (DKD), identify an optimal risk threshold, and explore the implications of different antihypertensive drug classes on DBPV and renal outcomes.

Key Findings:

• 24-hour DBP ARV was the strongest predictor of renal outcomes, directly linked to the study's objectives.
• Each 1 mmHg increase in DBP ARV was associated with 18% higher odds of rapid eGFR decline.
• Optimal threshold for DBP ARV predicting ESRD was 10.2 mmHg, with increased risk above this threshold.
• Patients with increased DBPV over time had a 2.4-fold higher ESRD risk.
• Calcium channel blockers (CCBs) were associated with lower DBP ARV compared to RAAS inhibitors or beta-blockers.

Interpretation:

The findings indicate that 24-hour DBP ARV is an independent predictor of renal progression in DKD, with rising DBPV amplifying renal risk, suggesting that CCBs may be more effective in reducing DBPV and improving patient outcomes.

Limitations:

• Single-center study may limit generalizability and introduce potential biases.
• Findings require validation in external multi-center cohorts.

Conclusion:

Incorporating ABPM-derived DBPV into DKD management improves risk stratification and supports personalized interventions, highlighting the need for further research to validate these findings.