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Hypertension speeds diabetes progression, increases CVD risk
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Adults with impaired glucose tolerance and hypertension are at greater risk for diabetes and cardiovascular disease events than those without hypertension, according to findings published in the Journal of Diabetes.
The findings were based on a post hoc analysis of the Da Qing Diabetes Prevention Study performed by Guangwei Li, MD, of the Center of Endocrinology and Cardiology at Fuwai Hospital and the Chinese Academy of Medical Sciences in Beijing, and colleagues. The original study measured 2-hour plasma glucose levels after a breakfast of 100 g of steamed bread among 110,660 adults in China in 1986. Participants then attended biannual follow-up for 6 years.
Li and colleagues conducted their analysis as a 23-year follow-up in 568 participants who had IGT from the original study to asses diabetes prevalence and the incidence of CVD events. The cohort was divided into two groups, with one composed of participants with hypertension at baseline (n = 297; mean age, 47.4 years; 43.4% women) and the other composed of participants without hypertension (n = 271; mean age, 42.8 years; 48% women).
Li and colleagues found a higher incidence of diabetes in participants with hypertension at baseline (80.8%) compared with participants without hypertension (72.3%; P = .02). Participants with hypertension at baseline were 26% more likely to develop diabetes (HR =1.26%; 95% CI, 1.04-1.54) than their nonhypertensive counterparts.
For every 1-mmol/L increase in 2-hour plasma glucose at baseline in participants with hypertension, there was a 25% increase in risk for diabetes (HR = 1.25; 95% CI, 1.08-1.44). The same participants had a 9% increase in risk for diabetes development for every 10-mm Hg increase in systolic blood pressure (HR = 1.09; 95% CI, 1.02-1.16). For participants without hypertension, the associated increase in risk for diabetes development was 36% (HR = 1.36; 95% CI, 1.16-1.6) for every 1-mmol/L increase of 2-hour plasma glucose. However, an association between systolic BP and diabetes development was not found in this group.
The risk for CVD events was higher for participants with hypertension at baseline (46.2%) compared with participants without hypertension (31.5%; P =. 04). This equated to a 35% higher risk for a CVD event for participants with hypertension (HR = 1.35; 95% CI, 1.01-1.81). CVD event incidence was higher after the development of diabetes for participants with hypertension (HR = 1.77; 95% CI, 1.21-2.58) and without (HR = 2.09; 95% CI, 1.22-3.59). The researchers noted a 97% higher risk for a CVD event associated with the progression from IGT to diabetes (HR = 1.97; 95% CI, 1.38-2.8). Additionally, for every 10-mm Hg increase in systolic BP, there was a 7% increase in risk for a CVD event (HR = 1.07; 95% CI, 1.01-1.12).
“There is growing recognition that individuals with IGT represent a high-risk population and should be treated more aggressively to prevent CV events,” Li and colleagues wrote. “Findings in our study suggested that preventing the onset of [diabetes] and decreasing the BP should be considered key strategies for reducing the macro-complications of diabetes.” – by Phil Neuffer
Disclosures: The authors report no relevant financial disclosures.
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