Abstract 9692: Lower Achieved Systolic Pressure (≤130 mm Hg) is Associated With a Decreased Risk of New Diabetes Mellitus in Hypertensive Patients With Electrocardiographic Left Ventricular Hypertrophy: The LIFE Study

Abstract

Background: There is a well-established association between higher blood pressure (BP) and insulin resistance and hypertensive patients are at increased risk of developing diabetes mellitus (DM). Although lower achieved systolic BP (SBP) was not associated with reduced mortality or cardiovascular outcomes in diabetic hypertensives or in hypertensive patients with ECG left ventricular hypertrophy (LVH) in the LIFE study, whether more aggressive reduction of SBP is associated with a lower incidence of DM has not been examined.

Methods: Risk of new-onset DM was examined in relation to last in-treatment SBP prior to DM diagnosis or last in-study measurement in the absence of new DM in 7485 hypertensive patients with ECG LVH with no history of DM randomly assigned to losartan- or atenolol-based treatment. Patients with in-treatment SBP ≤130 mm Hg (lowest quintile at last measurement) and SBP between 131 and 141, were compared with patients with in-treatment SBP ≥142 (median SBP at last measurement).

Results: During 4.6±1.2 years follow-up, new-onset DM was diagnosed in 520 patients (6.9%). In univariate analyses, compared with in-treatment SBP ≥142, in-treatment SBP ≤130 entered as a time-varying covariate was associated with a 57% lower risk (95% CI 39-69%) of new DM and in-treatment SBP between 131 and 141 with a 30% lower risk (95% CI 14-42%) of developing DM. After adjusting for randomized treatment, age, sex, race, prior antihypertensive therapy, baseline body mass index (BMI), uric acid, serum glucose and baseline HDL cholesterol entered as standard covariates, and for in-treatment Cornell product LVH, diastolic BP, BMI, HDL, hydrochlorothiazide and statin use treated as time-varying covariates, achievement of a SBP ≤130 remained associated with a 38% lower incidence (95% CI 12-57%) of new DM whereas an in-treatment SBP between 131 and 141 was no longer predictive of a reduced risk of new DM.

Conclusions: Achieved SBP ≤130 is associated with a significantly lower risk of developing new-onset DM in hypertensive patients with ECG LVH, independent of other known and possible risk factors for DM. Further study will be needed to determine whether targeting hypertensive patients without DM to lower SBP goals can reduce the burden of new DM in this high-risk population.