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Diabetes and cardiovascular events in hypertensive patients
M H Alderman1, H Cohen, S Madhavan
1lbert Einstein College of Medicine, Department of Epidemiology and Social Medicine, Bronx, NY, USA. alderman@aecom.yu.edu
Insights
A history of diabetes significantly increases cardiovascular disease (CVD) risk in hypertensive patients. Self-reported diabetes history is a stronger CVD predictor than blood sugar levels.
Area of Science:
- Cardiology
- Endocrinology
- Public Health
Background:
- Hypertension and diabetes are common comorbidities.
- Elevated blood sugar levels are associated with increased cardiovascular disease (CVD) risk.
- The predictive value of self-reported diabetes history versus glycemic control for CVD in hypertensive patients requires further clarification.
Purpose of the Study:
- To investigate the relationship between self-reported diabetes history, baseline blood sugar, and in-treatment blood sugar with subsequent CVD risk in treated hypertensive patients.
- To compare the predictive power of diabetes history versus glycemic measures for CVD events.
Main Methods:
- A cohort of 6886 treated hypertensive patients was assessed.
- Participants were stratified based on baseline and in-treatment blood sugar levels (<6.11, 6.11–7.74, and ≥7.75 mmol/L).
- Cox multivariate analysis was used to evaluate CVD event incidence over a mean 6.3-year follow-up.
Main Results:
- Patients with a history of diabetes had a 2-fold higher CVD incidence compared to those without.
- Self-reported diabetes history was a stronger predictor of CVD events (HR 2.37) than baseline (HR 1.75) or in-treatment blood sugar (HR 1.55).
- In patients with a history of diabetes, glycemic measures did not independently predict CVD risk.
- Elevated in-treatment blood sugar in frequent diuretic users was associated with significantly higher CVD event rates.
Conclusions:
- The coincidence of diabetes and hypertension is common, with diabetes substantially increasing CVD risk.
- Self-reported history of diabetes is a more powerful predictor of CVD events in hypertensive individuals than measured blood sugar levels.
- Hyperglycemia in hypertensive patients using diuretics, even with controlled blood pressure, is linked to increased CVD risk.
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.