Published Online
on August 6, 2007

A more recent version of this article appeared on September 1, 2007

This Article Full Text (PDF) CME: Take the course for this article: Hypertension: September 2007, Volume 50, Number 3 All Versions of this Article: 50/3/467    most recent HYPERTENSIONAHA.106.085654v1 Alert me when this article is cited Alert me if a correction is posted 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 Aksnes, T. A. Articles by Julius, S. Search for Related Content PubMed PubMed Citation Articles by Aksnes, T. A. Articles by Julius, S. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Medline Plus Health Information Blood Pressure Medicines Diabetes Complications High Blood Pressure Related Collections Type 2 diabetes Clinical Studies Related Article

Submitted on December 12, 2006
Revised on January 2, 2007

Impact of New-Onset Diabetes Mellitus on Cardiac Outcomes in the Valsartan Antihypertensive Long-Term Use Evaluation (VALUE) Trial Population

Tonje A. Aksnes^*; Sverre E. Kjeldsen; Morten Rostrup; Per Omvik; Tsushung A. Hua; and Stevo Julius

From the Departments of Cardiology (T.A.A., S.E.K.) and Acute Medicine (M.R.), Ullevaal University Hospital, Oslo, Norway; Institute of Internal Medicine (P.O.), Department of Cardiology, Haukeland University Hospital, Bergen, Norway; Novartis Pharma (T.A.H.), East Hanover, NJ; and the Division of Cardiovascular Medicine (S.J.), University of Michigan, Ann Arbor.

^* To whom correspondence should be addressed. E-mail: TonjeAmb.Aksnes{at}ulleval.no.

Abstract—There has been a lot of interest about new-onset diabetes mellitus in recent hypertension trials, but the implications of diabetes development on cardiac outcomes have not been known. In the Valsartan Antihypertensive Long-Term Use Evaluation trial, 15 245 high-risk patients were followed for an average of 4.2 years. At baseline, 5250 patients were diabetic by the 1999 World Health Organization criteria, and among the 9995 nondiabetic patients, 1298 patients developed diabetes during follow-up. We have investigated the influence of diabetes development on outcomes in the Valsartan Antihypertensive Long-Term Use Evaluation trial. The patients with diabetes at baseline and new-onset diabetes were compared with patients who did not develop diabetes by a Cox regression model with adjustment for prespecified covariates (age, diabetes status, left ventricular hypertrophy, baseline coronary heart disease, and randomized study treatment). Patients with diabetes at baseline had the highest cardiac morbidity defined as myocardial infarction and heart failure with a hazard ratio of 2.20 (95% CI: 1.95 to 2.49). The patients with new-onset diabetes had significantly higher cardiac morbidity, especially more congestive heart failure, than those without diabetes, with a hazard ratio of 1.43 (95% CI: 1.16 to 1.77). This indicates that patients who develop diabetes during antihypertensive treatment have cardiac morbidity intermediate between diabetic subjects and those subjects who never had diabetes and that it is of importance to find these patients at risk of diabetes development and optimize lifestyle and medical treatment.

Key words: congestive heart failure • diabetes mellitus • hypertension • morbidity • myocardial infarction • stroke

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