Abstract
This study evaluated the association between systolic blood pressure (SBP) and diabetic retinopathy (DR) across different glycemic levels in a Japanese population. We analyzed data from 1,049 residents aged ≥ 40 years with diabetes who underwent ophthalmic screening in Chikusei City. Participants were stratified into four groups by glycated hemoglobin (HbA1c) level (< 7% or ≥ 7%) and SBP (< 140 or ≥ 140 mmHg). Logistic regression was used to examine associations between SBP and prevalent DR within HbA1c strata. DR was present in 136 participants (13.0%), including 82 (7.8%) with mild-to-moderate nonproliferative DR (NPDR) and 54 (5.1%) with severe NPDR or proliferative DR (PDR). Among participants with lower HbA1c levels, higher SBP was significantly associated with greater odds of DR (odds ratio, 2.21; 95% confidence interval, 1.16–4.23). A similar association was observed among those with mild-to-moderate NPDR, but not among participants with higher HbA1c levels. SBP was not significantly associated with severe NPDR or PDR in any group. These findings suggest that elevated SBP may contribute to the development of early-stage DR even in individuals with well-controlled blood glucose levels, underscoring the importance of blood pressure management in DR prevention strategies.
Data availability
The data that support the findings of this study are available on request from the corresponding author, MS or KYa. The data are not publicly available due to their containing information that could compromise the privacy of research participants.
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Acknowledgements
We sincerely thank the medical staff for their skilled technical support and the dedicated personnel of Chikusei City for their invaluable assistance in conducting the survey. We are also deeply grateful to Dr. Hidemasa Torii, Dr. Yusaku Katada, Dr. Erisa Yotsukura, Dr. Hiromitsu Kunimi, and Dr. Mari Ibuki of Keio University School of Medicine for their essential contributions to the evaluation of retinal fundus images.
Funding
The authors have no proprietary or commercial interest in any materials discussed in this article (no financial or nonfinancial). This study was supported in part by a Grant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science, Japan (JSPS KAKENHI, 20K10490) to MS. The cohort study was originally supported by the National Cancer Center Research and Development Fund.
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Design of the study (MS); Conduct of the study (MS, KYa, KYu); collection and management of the data (MS, KYu, AH, KYa, TK, YT, KM, NO, YOz); analysis of the data (MS); interpretation of the data (MS, AH); preparation of the manuscript (MS, YOf); review and approval of the manuscript (MS, YOf, AH, TK, YT, KM, NO, YOz, Kya, Kyu, NS, KT, KN, ST, HI).
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Sasaki, M., Ofuji, Y., Hanyuda, A. et al. Clinical implications of systolic blood pressure for diabetic retinopathy across HbA1c levels in a Japanese population. Sci Rep (2026). https://doi.org/10.1038/s41598-026-35660-w
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DOI: https://doi.org/10.1038/s41598-026-35660-w
