OBJECTIVE -To compare the prevalence, awareness, treatment, and control of hypertension in a population-representative sample of adults with type 1 diabetes and comparable nondiabetic control subjects. , the Coronary Artery Calcification in Type 1 Diabetes Study enrolled 1,416 individuals aged 19 -56 years with no known history of coronary artery disease: 652 type 1 diabetic patients (46% male, mean age 37 years) and 764 nondiabetic control subjects (50% male, mean age 39 years). Subjects were asked if they had been told by a physician that they had hypertension or were on a blood pressure medication. Blood pressure was measured using standardized Joint National Committee (JNC) protocol.
RESEARCH DESIGN AND METHODSRESULTS -Type 1 diabetic subjects, compared with nondiabetic subjects, had higher rates of hypertension prevalence (43 vs. 15%, P Ͻ 0.001), awareness (53 vs. 45%, P ϭ 0.11), treatment (87 vs. 47%, P Ͻ 0.001), and control (55 vs. 32%, P Ͻ 0.001) for the JNC 6 goal (130/85 mmHg). Only 42% of all type 1 diabetic hypertensive subjects met the new JNC 7 goal (130/80 mmHg). Type 1 diabetic subjects had better blood pressure control (72 vs. 32%, P Ͻ 0.0001), using 140/90 mmHg as a common measure. The majority of treated subjects were on a single antihypertensive agent (75 vs. 64%).CONCLUSIONS -Subjects with type 1 diabetes have higher rates of hypertension prevalence, treatment, and control than nondiabetic subjects. However, hypertension remains largely uncontrolled, even if treated in high-risk populations, such as type 1 diabetic subjects and undiagnosed individuals in the general population. Achieving more stringent blood pressure goals will require increased attention and may necessitate the use of multiple antihypertensive agents.
Diabetes Care 28:301-306, 2005N umerous advances in care have led to improved health and longer survival in patients with type 1 diabetes. Hypertension has been estimated to affect ϳ30% of type 1 diabetic patients and usually reflects the development of diabetic nephropathy (1). Effective control of blood pressure is a well-established target to decrease morbidity and mortality in patients with type 1 diabetes and nondiabetic individuals as well (1,2).In type 1 diabetes, hypertension is related to an increased risk of microvascular complications, such as retinopathy (3-5), and is a modifiable risk factor in the progression of nephropathy (6) as well as in the development of the macrovascular complications of cardiovascular disease (7,8). The risk of cardiovascular disease doubles with each increase of 20/10 mm/Hg beginning at 115/75 mm/Hg (2). It has been estimated that 35-75% of diabetes complications are due to hypertension (9). Recently revised guidelines have been published by both the American Diabetes Association (ADA) (1) and the Joint National Committee (JNC) 7 (2) regarding goals for blood pressure treatment.Reports on prevalence, awareness, treatment, and control of hypertension exist for the general population (10,11) and the type 2 diabetic population (12-16), wher...