Mid-life blood pressure levels and the 8-year incidence of type 2 diabetes mellitus: the Rancho Bernardo Study

Abstract

Type 2 diabetes mellitus (T2DM) and hypertension frequently occur together. We examined whether blood pressure (BP) levels predict eight-year incident diabetes. Participants were community-dwelling older adults who had BP measured twice and an oral glucose tolerance test at baseline and again 8.3 years later. At baseline, participants were classified as normotensive [systolic (SBP) <120 mmHg and diastolic (DBP) <80 mmHg; n=242]; prehypertensive (SBP ≥120 and <140 mmHg or DBP ≥80 and <90 mmHg; n=426); or hypertensive (SBP ≥140 mmHg or DBP ≥90 mmHg or using anti-hypertensive medication; n=457). There were 1125 participants (mean age 66.0 years; 44.3% men) who attended the baseline and follow-up visit, of whom 85 had new onset T2DM. Participants who developed T2DM had higher mean body mass index (BMI) and BP levels than those who did not develop diabetes. In logistic regression models adjusted for age, sex, BMI, and physical activity, the odds of incident T2DM was greater in prehypertensives (OR2.32 95%CI 1.05–5.1, P=0.03) and hypertensives (OR3.5 95%CI 1.50–8.0, P=0.002) compared to normotensives. Excluding participants who used anti-hypertensive medications did not change results. In conclusion, mid-life hypertension and prehypertension predicted future diabetes, independent of BMI. Glucose surveillance should be encouraged in adults with prehypertension or hypertension.

Family history of diabetes modifies the effect of blood pressure for incident diabetes in Middle Eastern women: Tehran Lipid and Glucose Study

“…20 There are some other studies that show SBP as an independent predictor of diabetes despite adjustment for parental history of diabetes in the sex-adjusted model but not in the sex-stratified analysis. 9,21 Further studies are needed to clarify the causes underlying our finding. Abbreviations: aROC, area under the receiver operating characteristic; CI, confidence interval; DBP, diastolic blood pressure; MAP, mean arterial pressure; PP, pulse pressure; SBP, systolic blood pressure.…”

“…In a prospective study, after E8 years follow-up, DBP did not have a significant OR for incident diabetes, neither in the sex-adjusted model, including family diabetes history, nor in the models without adjustment for it. 21 In the women of Finnmark Study, DBP was associated with incident diabetes in the age-adjusted model but not in the multivariable-adjusted model. 22 Although many studies examined PP and MAP as predictors of CVD, 23,24 there is lack of data regarding the effect of these components for prediction of diabetes, compared with other BP components.…”

“…22 Although many studies examined PP and MAP as predictors of CVD, 23,24 there is lack of data regarding the effect of these components for prediction of diabetes, compared with other BP components. Kramer et al 21 in the Rancho Bernardo study showed that 10 mm Hg increases in PP causes a 20% increase in risk of diabetes in the multivariable-adjusted model. We found no data regarding evaluation of MAP on this issue.…”

“…In line with our results, there is some evidence indicating that prehypertension is significantly associated with diabetes. 21 We determined that prehypertension in women without family history of diabetes is associated with diabetes. The marginally significant association of prehypertension and hypertension with diabetes in the current study might be partly attributable to the limited statistical power.…”

Diabetic heart disease: the story continues

“…Recent studies have provided some epidemiological and pathophysiological insights. [26][27][28] Further work is clearly needed.…”