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 Tenenbaum, A. Articles by Motro, M. Search for Related Content PubMed PubMed Citation Articles by Tenenbaum, A. Articles by Motro, M. Related Collections Nutrition Clinical genetics Other hypertension

(Hypertension. 1999;33:1002-1007.)
© 1999 American Heart Association, Inc.

Scientific Contributions

Hypertension in Diet Versus Pharmacologically Treated Diabetics

Mortality Over a 5-Year Follow-Up

Alexander Tenenbaum; Enrique Z. Fisman; Valentina Boyko; Uri Goldbourt; Eran Graff; Joseph Shemesh; Avraham Shotan; Henrietta Reicher-Reiss; Solomon Behar; Michael Motro

From the Cardiac Rehabilitation Institute and the Bezafibrate Infarction Prevention Coordinating Center, Neufeld Cardiac Research Institute, the Chaim Sheba Medical Center, Tel-Hashomer, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

Correspondence to Alexander Tenenbaum, MD, PhD, Cardiac Rehabilitation Institute, Chaim Sheba Medical Center, 52621 Tel-Hashomer, Israel. E-mail zfisman{at}post.tau.ac.il

Abstract—The natural history of non–insulin-dependent diabetes mellitus (NIDDM) differs markedly between patients with diet treated and pharmacologically treated disease. However, the interrelationship between hypertension and these common diabetes types has not been specifically addressed in previous studies. This study was designed to evaluate the prognostic significance and prevalence of hypertension in coronary patients with diet versus pharmacologically treated NIDDM over a 5-year follow-up period. The study sample comprised 11 515 patients aged 45 to 74 years with a previous myocardial infarction and/or anginal syndrome who had been screened but were not included in the Bezafibrate Infarction Prevention study. Among them, 9033 were nondiabetics and 2482, diabetics (987 diet treated and 1495 pharmacologically treated). The prevalence of hypertension among nondiabetics, diet-treated diabetics, and pharmacologically treated diabetics was 31%, 42%, and 43%, respectively. Crude all-cause mortality (CM) was lower in the nondiabetic patients (11.2% versus 22.0%; P<0.001). Among diabetics, 548 patients died: 81 diet treated normotensives (CM 14%); 100 diet-treated hypertensives (CM 24.4%); 205 pharmacologically treated normotensives (CM 24.2%); and 162 pharmacologically treated hypertensive patients (CM 25.0%). Age-adjusted mortality was lowest for the normotensive patients in the diet-treated group and highest for the hypertensive pharmacologically treated patients. Multivariate analysis shows that hypertension is a strong and independent predictor of increased CM in diet-treated but not in pharmacologically treated NIDDM: hazard ratio (HR) was 1.68 (95% confidence interval [CI] 1.24 to 2.29) for the diet-treated versus 1.01 (95% CI 0.82 to 1.26) for the pharmacologically treated diabetics. The contribution of hypertension to stroke mortality was substantial for both diet treated and pharmacologically treated NIDDM: hazard ratios were 3.17 (95% CI 1.12 to 8.98) and 2.21 (95% CI 0.72 to 6.77), respectively. The increased risk of mortality associated with hypertension in relatively mild diet-treated NIDDM strongly supports the clinical benefit of early blood pressure control among diabetic patients with ischemic heart disease.

Key Words: coronary disease • diabetes mellitus • hypertension • mortality

This article has been cited by other articles:

				Hypertension, Diabetes, and Coronary Disease Journal Watch Cardiology, June 11, 1999; 1999(611): 8 - 8. [Full Text]