Insufficient Control of Blood Pressure and Incident Diabetes

Abstract

OBJECTIVE -Incidence of type 2 diabetes might be associated with preexisting hypertension. There is no information on whether incident diabetes is predicted by blood pressure control. We evaluated the hazard of diabetes in relation to blood pressure control in treated hypertensive patients.RESEARCH DESIGN AND METHODS -Nondiabetic, otherwise healthy, hypertensive patients (N ϭ 1,754, mean Ϯ SD age 52 Ϯ 11 years, 43% women) participated in a network over 3.4 Ϯ 1 years of follow-up. Blood pressure was considered uncontrolled if systolic was Ն140 mmHg and/or diastolic was Ն90 mmHg at the last outpatient visit. Diabetes was defined according to American Diabetes Association guidelines.RESULTS -Uncontrolled blood pressure despite antihypertensive treatment was found in 712 patients (41%). At baseline, patients with uncontrolled blood pressure were slightly younger than patients with controlled blood pressure (51 Ϯ 11 vs. 53 Ϯ 12 years, P Ͻ 0.001), with no differences in sex distribution, BMI, duration of hypertension, baseline blood pressure, fasting glucose, serum creatinine and potassium, lipid profile, or prevalence of metabolic syndrome. During follow-up, 109 subjects developed diabetes. Incidence of diabetes was significantly higher in patients with uncontrolled (8%) than in those with controlled blood pressure (4%, odds ratio 2.08, P Ͻ 0.0001). In Cox regression analysis controlling for baseline systolic blood pressure and BMI, family history of diabetes, and physical activity, uncontrolled blood pressure doubled the risk of incident diabetes (hazard ratio [HR] 2.10, P Ͻ 0.001), independently of significant effects of age (HR 1.02 per year, P ϭ 0.03) and baseline fasting glucose (HR 1.10 per mg/dl, P Ͻ 0.001).CONCLUSIONS -In a large sample of treated nondiabetic hypertensive subjects, uncontrolled blood pressure is associated with twofold increased risk of incident diabetes independently of age, BMI, baseline blood pressure, or fasting glucose.

Hypertensive target organ damage predicts incident diabetes mellitus

“…4,5 Diabetes also worsens survival in patients who develop clinical CVD. 6 We have previously demonstrated that uncontrolled blood pressure (BP) is associated with a two-fold increased risk of incident diabetes in treated hypertensive subjects, 7 extending previous observations indicating that incident diabetes is more frequent in hypertensive than in normotensive subjects, 8 and that combinations of hypertension, obesity, and abnormal lipid profile, which often coexist with diabetes, are associated with preclinical cardiovascular abnormalities. 1,9,10 Interestingly, clusters of metabolic abnormalities and the presence of LVH are also reported to increase the probability of uncontrolled hypertension.…”

“…These findings are eventually reinforced by the evidence that poor therapeutic control of BP further increases the risk of incident diabetes in hypertensive subjects. 7 Considering this evidence, it is not surprising that we found that conditions of preclinical CVD, such as LVH and CA, precede and predict incident diabetes.…”

“…Thus, all medications used for more than 50% of control visits were considered as covariates in proportional hazards analysis, a method that has been previously reported. 7 Incident diabetes in relation to the presence of either initial LVH or CA was assessed using two models of the Cox regression analysis (one for each marker), controlling for demographic, haemodynamic, and metabolic variables participating to the phenotypes of MetS (age, sex, reported duration of hypertension, initial BP, heart rate, BMI, fasting glucose, HDL-cholesterol, triglycerides) and number and type of antihypertensive medications that were significantly different in exploratory statistics. In alternative Cox models, we assessed the effect of the generic presence of either one of the two markers of preclinical CVD (LVH or CA) or both, adjusting for the same covariates.…”

“…Detailed characteristics of this population have been previously reported. 7,12 Exclusion criteria for the present analysis were: pre-existing CVD, diabetes, secondary hypertension, chronic kidney disease more than grade 3 (GFR by simplified MDRD ,30 mL/min/1.73 m 2 ), aortic and/or mitral regurgitation more than mild, any degree of aortic stenosis, and follow-up ,1 year. Pre-existing CVD was defined as the history of previous myocardial infarction, angina, coronary revascularization, stroke, transitory ischaemic attack, and congestive heart failure at the time of the admission visit in our outpatient clinic.…”

Implication of the Fixed Combinations in the Hypertension Treatment

“…Следует пом-нить о том, что само по себе наличие АГ ассоциировано с более высоким риском развития сахарного диабета в течение жизни. О том, что недостаточный контроль АД на фоне антигипертензивной терапии может быть независимым фактором риска развития сахарного диабета, показало исследование Izzo R et al [25]. При наблюдении за 1 754 пациентами без сахарного диа-бета (средний возраст 52 года, 43% женщины), по-лучавшими антигипертензивную терапию, в течение 3,4 лет у 109 развился сахарный диабет.…”