Insufficient control of blood pressure and incident diabetes

Abstract

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

Research design and Methods: Non-diabetic, otherwise healthy, hypertensive patients (n=1754, age 52±11yrs, 43% women) participated in a network over 3.4±1yr follow-up. BP was considered uncontrolled when systolic ≥140mmHg or/and diastolic ≥90mmHg at last outpatient visit. Diabetes was defined according to ADA guidelines.

Results: Uncontrolled BP despite antihypertensive treatment was found in 712 patients (41%). At baseline, patients with uncontrolled BP were slightly younger than patients with controlled BP (51±11 vs 53±12yrs; p<0.001) with no differences in gender distribution, body mass index, duration of hypertension, baseline BP, 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 BP (8%) than in those with controlled BP (4 %; OR= 2.08; p<0.0001). In Cox analysis, controlling for baseline systolic BP and body mass index, familiarity and physical activity, uncontrolled BP doubled risk of incident diabetes (HR= 2.10; p<0.001), independently of significant effect of age (HR= 1.02/yr; p=0.03) and baseline fasting glucose (HR=1.10/mg×dL⁻¹; p<0.001).

Conclusion: In a large sample of treated non-diabetic hypertensive subjects, uncontrolled BP is associated with 2-fold increased risk of incident diabetes independently of age, body max index, baseline BP and fasting glucose.