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Risk for incident hypertension reduced by intensive insulin therapy in type 1 diabetes
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Intensive insulin therapy may reduce the long-term risk for developing hypertension in patients with type 1 diabetes.
Researchers from the University of Washington at Seattle and other U.S. sites conducted the Diabetes Control and Complications Trial (DCCT) and the Epidemiology of Diabetes Intervention and Complications study (EDIC), to analyze the effects of intensive insulin therapy and hyperglycemia on the development of hypertension in patients with diabetes.
Six-hundred thirty of 1,441 participants developed hypertension during a median follow-up of 15.8 years. The researchers defined incident hypertension as two consecutive study visits with a systolic blood pressure of 140 mmHg or higher, diastolic blood pressure of 90 mmHg or higher or use of antihypertensive medications.
The incidence of hypertension was similar between the intensive and conventional therapy groups during the DCCT trial, though intensive therapy during DCCT reduced the risk for incident hypertension by 24% during the EDIC study follow-up (HR=0.76).
Increased risk for incident hypertension was linked to higher HbA1c levels at baseline (HR=1.11 for each 1% higher HbA1c level) or follow-up (HR=1.25 for each 1% higher HbA1c level).
“Glycemic control appeared to mediate the antihypertensive benefit of intensive therapy,” the researchers wrote.
Independent associations with hypertension were older age, male sex, family history, greater baseline BMI, weight gain and a greater albumin excretion rate.
Arch Intern Med. 2008;168:1867-1873.