This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Sievers, M. L. Articles by Nelson, R. G. Search for Related Content PubMed PubMed Citation Articles by Sievers, M. L. Articles by Nelson, R. G. Pubmed/NCBI databases Substance via MeSH Medline Plus Health Information High Blood Pressure Native-American Health

(Circulation. 1999;100:33-40.)
© 1999 American Heart Association, Inc.

Clinical Investigation and Reports

Effect of Hypertension on Mortality in Pima Indians

Maurice L. Sievers, MD; Peter H. Bennett, MB, MRCP, FFCM; Janine Roumain, MD, MPH; Robert G. Nelson, MD, PhD

From the Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona.

Correspondence to Dr Robert G. Nelson, National Institutes of Health, 1550 East Indian School Road, Phoenix, AZ 85014-4972. E-mail rnelson{at}phx.niddk.nih.gov

Background—The effect of hypertension on mortality was examined in 5284 Pima Indians, 1698 of whom had type 2 diabetes at baseline or developed it during follow-up.

Methods and Results—During a median follow-up of 12.2 years (range, 0.01 to 24.8 years), 470 nondiabetic subjects and 488 diabetic subjects died. In the nondiabetic subjects, 45 of the deaths were due to cardiovascular disease, 208 to other natural causes, and 217 to external causes; in the diabetic subjects, 106 of the deaths were due to cardiovascular disease, 85 to diabetic nephropathy, 226 to other natural causes, and 71 to external causes. In the nondiabetic subjects, after adjusting for age, sex, body mass index, and serum cholesterol concentration in a proportional hazards model, hypertension predicted death from cardiovascular disease (death rate ratio [DRR]=2.8; 95% CI, 1.4 to 5.6; P=0.003). In the diabetic subjects, after additional adjustment for duration of diabetes, plasma glucose concentration, and proteinuria, hypertension strongly predicted deaths from diabetic nephropathy (DRR=3.5; 95% CI, 1.7 to 7.2; P<0.001), but it had little effect on deaths from cardiovascular disease (DRR=1.4; 95% CI, 0.88 to 2.3; P=0.15).

Conclusions—We propose that the weak relationship between hypertension and cardiovascular disease in diabetic Pima Indians is not because of a diminished effect of hypertension on cardiovascular disease in diabetes, but because of a relatively greater effect of hypertension on the progression of diabetic nephropathy. Factors that may account for this finding in Pima Indians include a younger age at onset of type 2 diabetes, a low frequency of heavy smoking, favorable lipoprotein profiles and, possibly, enhanced susceptibility to renal disease.

Key Words: cardiovascular diseases • diabetes mellitus • epidemiology • hypertension • Indians, North American • mortality • proportional hazards models

This article has been cited by other articles:

				C. Wilson, S. Gilliland, T. Cullen, K. Moore, Y. Roubideaux, L. Valdez, W. Vanderwagen, and K. Acton Diabetes Outcomes in the Indian Health System During the Era of the Special Diabetes Program for Indians and the Government Performance and Results Act Am J Public Health, September 1, 2005; 95(9): 1518 - 1522. [Abstract] [Full Text] [PDF]

				A. Saremi, R. G. Nelson, M. Tulloch-Reid, R. L. Hanson, M. L. Sievers, G. W. Taylor, M. Shlossman, P. H. Bennett, R. Genco, and W. C. Knowler Periodontal Disease and Mortality in Type 2 Diabetes Diabetes Care, January 1, 2005; 28(1): 27 - 32. [Abstract] [Full Text] [PDF]

				P. H. Dessein, A. E. Stanwix, Z. Moomal, D. Symmons, and B. Harrison Rheumatoid arthritis and cardiovascular disease may share similar risk factors Rheumatology, June 1, 2001; 40(6): 703 - 704. [Full Text] [PDF]