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New-onset diabetes risk rises with BP
Elevated BP may be a risk factor for new-onset type 2 diabetes, and the association appears strongest in those who are younger and have a lower BMI, according to an analysis of 4.1 million adults in the United Kingdom.
“A detailed understanding of BP as a potential risk factor for diabetes will help us better understand and communicate risks with patients and can lead to more targeted prevention and management,” Connor A. Emdin, HBSc, of the George Institute for Global Health, University of Oxford, England, and colleagues wrote.
Using validated linked electronic health records, Emdin and colleagues analyzed a cohort of 4,132,138 adults aged 30 to 90 years (55.9% women) in the U.K. Clinical Practice Research database who had BP measurements taken from January 1990 to January 2013, were registered at a general practice for 1 year, and had no pre-existing CVD and diabetes. The researchers examined the association of BP with new-onset diabetes, controlling for BMI, total cholesterol, HDL and smoking status. For this study, the baseline BP measurement was transformed into “usual BP,” controlling for measurement error and long-term fluctuations in BP, according to the researchers.
The primary outcome was diagnosis of type 2 diabetes or insulin/antidiabetic therapy prescription.
Overall, a 20-mm Hg higher systolic BP (HR = 1.58; 95% CI, 1.56-1.59) and 10-mm Hg higher diastolic BP (HR = 1.52; 95% CI, 1.51-1.54) were associated with greater risk for new-onset diabetes.
The strength of the association between diabetes risk and elevated BP declined with increasing BMI, the researchers reported. A 20-mm Hg higher systolic BP was associated with a greater increase in risk for diabetes in adults with a BMI up to 25 kg/m2 (HR = 1.89; 95% CI, 1.84-1.94) compared with a BMI greater than 35 kg/m2 (HR = 1.19; 95% CI, 1.16-1.22; P for interaction < .0001). A 10-mm Hg higher diastolic BP was associated with a greater increased risk for diabetes in adults with a BMI less than 20 kg/m2 (HR = 1.73; 95% CI, 1.68-1.78) compared with a BMI greater than 35 kg/m2 (HR = 1.19; 95% CI, 1.16-1.22; P for interaction < .0001).
When the researchers examined the association by age, they found that the risk for diabetes was increased among adults at age 30 to 50 years per 20-mm Hg higher usual systolic BP (HR = 2; 95% CI, 1.96-2.04) compared with age 71 to 90 years (HR = 1.14; 95% CI, 1.11-1.17). Results were similar per 10-mm Hg increase in diastolic BP (risk at age 30 to 50 years: HR = 1.89; 95% CI, 1.86-1.92; risk at age 71 to 90 years: HR = 1.01; 95% CI, 0.98-1.04).
Researchers also performed a meta-analysis of 30 observational studies (n = 285,664; 17,388 with diabetes), and found that a 20-mm Hg higher systolic BP was associated with a 77% higher risk of new-onset diabetes (RR = 1.77; 95% CI, 1.53-2.05). Adding the present study to the results did not change the findings, according to the researchers.
“In addition to confirming the overall effects from previous reports, our study’s large sample size extends previous reports by investigating the differences in associations by key populations, such as age, sex and BMI,” the researchers wrote.
However, “it is unclear whether the observed association between BP and diabetes is causal,” according to the researchers. Further research should examine whether the observed association is modifiable, they concluded.
Donna K. Arnett
In an editorial published in the Journal of the American College of Cardiology, Donna K. Arnett, MSPH, PhD, from the department of epidemiology, University of Alabama at Birmingham, said she does not foresee any changes to clinical practice.
“Although [the] findings may bolster evidence for an existing hypothesis, they are unlikely to motivate any changes in clinical practice,” Arnett wrote. “Association studies simply identify clinical correlates; they do not provide insights into the mechanisms that could contribute to the observed findings. … This study provides a strong rationale for continued research into the biological basis and pharmacological implications of the observed association.” – by Trish Shea, MA
Disclosure: One researcher reports consulting for Amgen and Novartis. See the full study for the other authors’ relevant financial disclosures.