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(Hypertension. 2006;47:410.)
© 2006 American Heart Association, Inc.

Original Articles

Prehypertension, Diabetes, and Cardiovascular Disease Risk in a Population-Based Sample

The Strong Heart Study

Ying Zhang; Elisa T. Lee; Richard B. Devereux; Jeunliang Yeh; Lyle G. Best; Richard R. Fabsitz; Barbara V. Howard

From the Center for American Indian Health Research (Y.Z., E.T.L., J.Y.), College of Public Health, University of Oklahoma, Health Sciences Center, Oklahoma City; Cornell University Medical Center (R.B.D.), New York, NY; Missouri Breaks Industries Research, Inc (L.G.B.), Timber Lake, SD; Epidemiology and Biometry Program (R.R.F.), National Heart, Lung, and Blood Institute, Bethesda, MD; and MedStar Research Institute (B.V.H.), Washington, DC.

Correspondence to Ying Zhang, MD, PhD, Center for American Indian Health Research, University of Oklahoma Health Sciences Center, PO Box 26901, Oklahoma City, OK 73190. E-mail Ying-zhang4{at}ouhsc.edu

There are few data about the impact of the recently-defined category of prehypertension (systolic blood pressure 120 to 139 mm Hg or diastolic blood pressure 80 to 89 mm Hg) on cardiovascular disease incidence. It is also unknown whether this association differs between individuals with or without diabetes. A total of 2629 Strong Heart Study participants free from hypertension and cardiovascular disease at baseline examination were followed for 12 years to observe incident cardiovascular disease. Approximately 42% of the 2629 participants had diabetes. We assessed the prevalence of prehypertension and the hazard ratios of incident cardiovascular disease associated with prehypertension. Prehypertension was more prevalent in diabetic than nondiabetic participants (59.4% versus 48.2%, P<0.001 adjusted for age). Compared with nondiabetic participants with normal blood pressure, the hazard ratios of cardiovascular disease were 3.70 (95% confidence interval: 2.66, 5.15) for those with both prehypertension and diabetes, 1.80 (1.28, 2.54) for those with prehypertension alone and 2.90 (2.03, 4.16) for those with diabetes alone. Impaired glucose tolerance or impaired fasting glucose also greatly increased the cardiovascular disease risk in prehypertensive people. Clinical investigation of more aggressive interventions, such as drug treatment for blood pressure control for prehypertensive individuals with impaired fasting glucose, impaired glucose tolerance, or diabetes is warranted.

Key Words: cardiovascular disease • cohort study • diabetes mellitus • prehypertension

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