Association of mean arterial pressure with 5-year risk of incident diabetes in Chinese adults：a secondary population-based cohort study

Abstract

ObjectiveHypertension predicts the development of diabetes. However, there are still lacking high-quality studies on the correlation between mean arterial pressure (MAP) and incident diabetes. We aimed to explore the relationship between MAP and diabetes in Chinese adults.DesignThis is a secondary retrospective cohort study and the data were downloaded from the ‘DATADRYAD’ database (www.Datadryad.org).ParticipantsThe study included 210 418 adults without diabetes at baseline between 2010 and 2016 across 32 sites and 11 cities in China.SettingThe target-independent and dependent variables were MAP measured at baseline and diabetes occurred during follow-up. Cox proportional hazards regression was used to explore the relationship between MAP and diabetes.Primary outcome measuresThe outcome was incident diabetes, which was defined as fasting blood glucose ≥7.00 mmol/L and/or self-reported diabetes during follow-up. Patients were censored either at the time of the diagnosis or at the last visit, whichever comes first.Results3927 participants developed diabetes during a 5-year follow-up. After adjusting covariates, MAP positively correlated with diabetes (HR=1.008, 95% CI 1.005 to 1.011, p<0.001), and the absolute risk difference was 0.02%. E-value analysis and multiple imputations were used to explore the robustness of the results. The relationship between MAP and diabetes was also non-linear, and the inflection point of MAP was 100.333 mm Hg. Subgroup analysis revealed a stronger association between MAP and diabetes in people with age (≥30,<50 years old), fasting plasma glucose <6.1 mmol/L and drinking. Additionally, receiver operating characteristic (ROC) curves showed the predictive performance of MAP for diabetes was similar to systolic blood pressure (SBP) (area under the curve (AUC)=0.694 with MAP vs AUC=0.698 with SBP).ConclusionsMAP is an independent predictor for a 5-year risk of incident diabetes among Chinese adults. The relationship between MAP and diabetes is also non-linear. When MAP is below 100.333 mm Hg, MAP is closely positively related to diabetes.

Association of mean arterial pressure with non-alcoholic fatty liver disease: results from the NAGALA study

“…In addition, the accuracy of using MAP to predict preeclampsia is better than SBP or DBP alone in early and midtrimester pregnancies (16, 17). Together, these previous studies supported that MAP is sufficiently advantageous in short-term event assessment, and in recent years, MAP has begun to be mentioned in epidemiological studies; several researchers have found MAP to be of good value in assessing the risk of developing various chronic diseases such as atherosclerosis (18), diabetes (19)(20)(21), chronic kidney disease (22,23), and metabolic syndrome (24), as well as in predicting poor prognosis in cardiovascular disease (9,(25)(26)(27)(28). A series of epidemiological evidence further suggested that MAP may be a useful assessment tool for common chronic diseases; however, data on the direction of the association between MAP and the risk of developing NAFLD are still scarce, and it is unclear whether MAP is associated with NAFLD in the general population, whether this association is non-linear, and whether there are differences across populations.…”

“…The occurrence of this result is understandable in our opinion, because when age increases beyond 60 years, there is a gradual decrease in cardiac and vascular compliance and an increase in arterial wall stiffness, followed by a significant decrease in DBP (39,40). While MAP is a composite of SBP and DBP, calculated as 1/3SBP + 2/3DBP (19), it can be seen that the contribution of DBP to the composition of MAP is greater. When DBP decreases significantly in older adults, MAP will also decrease significantly, and subsequently, MAP-related NAFLD risk is lower in data performance than in young and middle-aged populations.…”

“…Height, weight, waist circumference, and blood pressure were measured using standard methods in a standard setting, and BMI was calculated as weight/height 2 . MAP was calculated as 1/3 SBP + 2/ 3 DBP (19). Smoking status was divided into non-smoking, former smoking, and current smoking; drinking status was divided into non, light, and moderate based on the amount and type of weekly alcohol consumption in the past month (32).…”

Correlation Between TG/HDL-C Ratio or Triglyceride-Glucose Index and Mean Arterial Pressure in Patients with Myocardial Infarction: A Correlative Analytical Study

“…Lee et al [44] revealed a signi cant association between the TyG index and new-onset hypertension speci cally in females. Wu et al [45] established a positive correlation between MAP and diabetes in females. Furthermore, additional research [46] suggests that estrogens-related pathways may play a role, emphasizing the importance of conducting subgroup analyses considering menopause in the study.…”

Evaluating the relative importance of different blood pressure indices in screening for NAFLD: a survey report based on a health examination population

“…For survivors of myocardial infarction, studies showed that maintaining MAP above 80 was important for improving adverse outcomes ( 47 ). Additionally, recent epidemiological surveys have proposed gender-specific MAP thresholds for predicting metabolic syndrome in the elderly at 84 mmHg (male) and 83.3 mmHg (female) ( 48 ), a MAP threshold of 92.833 mmHg for predicting diabetes ( 49 ), and 88 mmHg (male) and 89 mmHg (female) for predicting non-obese NAFLD ( 34 ). In our current study, based on general health examination population data, we found the threshold for identifying NAFLD using MAP to be 88.75 mmHg.…”