Abstract 2450: Incident Diabetes in Hypertensive Patients with Uncontrolled Blood Pressure
Introduction: Incidence of type 2 diabetes increases with increasing blood pressure (BP) in women, according to modified categories from ESH/ESC 2007 guidelines (Conen D, Eur Heart J 2007). There is no information on relation between incident diabetes and BP control.
Hypothesis: to evaluate the hazard of diabetes in relation to BP control in treated hypertensive patients.
Methods: 1754 non-diabetic hypertensive patients (age 52±11 yrs, 43% women) underwent multiple clinical visits and lab testing during 3.4±1 year follow-up. BP was considered uncontrolled when systolic BP≥140mmHg or/and diastolic≥90mmHg. Diabetes was defined according to ADA (1997). Analysis was performed using last BP value before diagnosis of diabetes or BP at the last visit (in non diabetic subjects).
Results: Uncontrolled BP despite optimal multi-drug therapy was found in 712 patients (41% of population). At baseline, patients with uncontrolled BP at the follow-up were younger than patients whose BP was well controlled (51±11 vs 53±12 yrs; p< 0.001) with no differences in gender distribution, BMI, reported duration of hypertension, baseline BP values, fasting glucose, serum creatinine and potassium, lipid profile or prevalence of metabolic syndrome (ATPIII modified, by BMI substituting waist girth). During follow-up, 109 patients (6% of the population, 41% women) developed diabetes. Incidence of diabetes was significantly higher in patients with uncontrolled BP (8%) than in those with controlled BP (4 %; Odds Ratio [OR]= 2.08; p< 0.0001). In Cox analysis, controlling for baseline systolic BP and BMI, uncontrolled BP doubled risk of incident diabetes (HR= 2.10; 95%CI=1.41–3.12; p<0.001), independently of significant effect of age (HR= 1.02/year; 95%CI= 1.002–1.04; p=0.03) and baseline fasting glucose (HR=1.10/ mg×dL−1; 95%CI= 1.08 –1.13; p<0.001). Other variables, including sex, baseline systolic BP and BMI did not have any effect on prediction of diabetes in this model.
Conclusions: In a large clinical sample of treated initially non-diabetic hypertensive subjects, uncontrolled BP is associated with a 2-fold increased risk of incident diabetes independently of age, BMI, baseline BP and fasting glucose.