(Hypertension. 1999;33:1130-1134.)
© 1999 American Heart Association, Inc.
Scientific Contributions |
Diabetes and Cardiovascular Events in Hypertensive Patients
Presented in part at the 12th Scientific Meeting of the American Society of Hypertension, San Francisco, Calif, May 27 to 31, 1997, and published in abstract form (Am J Hypertens. 1997;10:17A).
From Albert Einstein College of Medicine, Department of Epidemiology and Social Medicine, Bronx, NY.
Correspondence to Dr Michael H. Alderman, Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine, 1300 Morris Park Ave, Room 1311 Belfer ECHS, Bronx, NY 10461. E-mail alderman{at}aecom.yu.edu
Abstract—To determine the
relation of self-reported history of diabetes as well as baseline and
in-treatment blood sugar to subsequent cardiovascular
disease (CVD) in treated hypertensive patients, we assessed the
experience of 6886 participants in a systematic treatment program. The
presence or absence of a history of diabetes was known for all
patients, who were then stratified into 3 groups according to blood
sugar at baseline and in treatment (<6.11, 6.11 to 7.74, and
7.75 mmol/L). Some 7.4% of all patients reported history of
diabetes, and the overall prevalence of blood sugar 7.75 mmol/L
was 7.7% and 10.4% at baseline and in treatment, respectively.
Patients with a history of diabetes were 10 or 8 times as likely to
have blood sugar 7.75 mmol/L at baseline (47.2% versus 4.5%)
or in treatment (55.0% versus 6.8%), as were patients without
history. During an average 6.3 years of follow-up, patients with
history of diabetes had a cardiovascular event
incidence 2-fold higher than those without history (20.8 versus
8.6/1000 person-years). Age-gender–adjusted CVD incidence rate but not
non-CVD was twice as high in the highest compared with the lowest blood
sugar stratum (baseline 16.6 versus 8.4/1000 person-years; in treatment
15.2 versus 8.2). Three separate models of Cox
multivariate analysis revealed that history of
diabetes (with no history as reference) had a greater association with
CVD events (hazard ratio 2.37, 95% confidence interval 1.80 to 3.11)
than did baseline (1.75, 1.31 to 2.33) or in-treatment blood sugar
(1.55, 1.19 to 2.02). Furthermore, in the presence of history of
diabetes (2.15, 1.58 to 2.92), neither baseline nor in-treatment blood
sugar was independently associated with CVD risk. In the elevated
(7.75 mmol/L) in-treatment blood sugar group, the
age-gender–adjusted rate of CVD events in frequent diuretic
users (30.79/1000 person-years) was significantly higher than in
moderate (13.34, P=0.004) and rare users (13.25,
P=0.008). These data affirm that the coincidence of
diabetes and hypertension is common, that evidence of diabetes
substantially increases CVD risk, that self-reported history is a more
powerful predictor of CVD events than any measure of blood sugar, and
that CVD increases in hypertensive diuretic users who develop
hyperglycemia even when blood pressure is well controlled.
Key Words: diabetes mellitus • hypertension, mild • blood glucose • cardiovascular diseases • hypertension detection and control
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