Insufficient control of blood pressure and incident diabetes.

Authors:
Raffaele Izzo
Raffaele Izzo
Hypertension Research Center
Winston-Salem | United States
Giovanni De Simone
Giovanni De Simone
Federico II University
Marcello Chinali
Marcello Chinali
DEPARTMENT OF PEDIATRIC CARDIOLOGY AND CADIAC SURGERY
MD PhD
CARDIOVASCULAR DISEASE
ROMA | Italy
Prof. Guido Iaccarino, MD, PhD
Prof. Guido Iaccarino, MD, PhD
Federico II University of Naples
Full Professor of Applied Medical Science and Technology
Cardiology
Napoli, Campania | Italy
Valentina Trimarco
Valentina Trimarco
Department of Clinical Medicine
Italy
Francesco Rozza
Francesco Rozza
University of Salerno
Fisciano | Italy
Renata Giudice
Renata Giudice
Federico II University Hospital
Italy
Bruno Trimarco
Bruno Trimarco
Federico II University
Napoli | Italy

Diabetes Care 2009 May 17;32(5):845-50. Epub 2009 Feb 17.

Department of Clinical Medicine, Cardiovascular, and Immunological Sciences, Federico II University-Naples, Naples, Italy.

Objective: Incidence of type 2 diabetes might be associated with preexisting hypertension. There is no information on whether incident diabetes is predicted by blood pressure control. We evaluated the hazard of diabetes in relation to blood pressure control in treated hypertensive patients.

Research Design And Methods: Nondiabetic, otherwise healthy, hypertensive patients (N = 1,754, mean +/- SD age 52 +/- 11 years, 43% women) participated in a network over 3.4 +/- 1 years of follow-up. Blood pressure was considered uncontrolled if systolic was >or=140 mmHg and/or diastolic was >or=90 mmHg at the last outpatient visit. Diabetes was defined according to American Diabetes Association guidelines.

Results: Uncontrolled blood pressure despite antihypertensive treatment was found in 712 patients (41%). At baseline, patients with uncontrolled blood pressure were slightly younger than patients with controlled blood pressure (51 +/- 11 vs. 53 +/- 12 years, P < 0.001), with no differences in sex distribution, BMI, duration of hypertension, baseline blood pressure, fasting glucose, serum creatinine and potassium, lipid profile, or prevalence of metabolic syndrome. During follow-up, 109 subjects developed diabetes. Incidence of diabetes was significantly higher in patients with uncontrolled (8%) than in those with controlled blood pressure (4%, odds ratio 2.08, P < 0.0001). In Cox regression analysis controlling for baseline systolic blood pressure and BMI, family history of diabetes, and physical activity, uncontrolled blood pressure doubled the risk of incident diabetes (hazard ratio [HR] 2.10, P < 0.001), independently of significant effects of age (HR 1.02 per year, P = 0.03) and baseline fasting glucose (HR 1.10 per mg/dl, P < 0.001).

Conclusions: In a large sample of treated nondiabetic hypertensive subjects, uncontrolled blood pressure is associated with twofold increased risk of incident diabetes independently of age, BMI, baseline blood pressure, or fasting glucose.

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Source
http://dx.doi.org/10.2337/dc08-1881DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2671117PMC

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May 2009
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