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Prevalence of hypertension in type 1 (insulin-dependent) diabetes mellitus
K Nørgaard1, B Feldt-Rasmussen, K Borch-Johnsen
1Steno Memorial Hospital, Gentofte, Denmark.
Insights
Hypertension is more common in Type 1 diabetes patients than the general population. However, essential hypertension rates are similar, suggesting it doesn't cause diabetic nephropathy.
Area of Science:
- Cardiology
- Endocrinology
- Nephrology
Background:
- Hypertension is a known complication in Type 1 diabetes.
- Diabetic nephropathy is a common cause of morbidity and mortality in Type 1 diabetes patients.
- The relationship between hypertension and diabetic nephropathy requires further investigation.
Purpose of the Study:
- To assess the prevalence of hypertension in Type 1 diabetic patients compared to the general population.
- To investigate the prevalence of essential hypertension in Type 1 diabetic patients.
- To determine if essential hypertension contributes to the development of diabetic nephropathy.
Main Methods:
- A representative sample of the Danish general population (n=10202) and Type 1 diabetic patients (n=1703) aged 16-59 years were included.
- Blood pressure was measured using three readings.
- Urinary albumin excretion was assessed to define essential hypertension and nephropathy.
Main Results:
- The prevalence of hypertension was 4.4% in the general population and 14.7% in Type 1 diabetic patients (p<0.00001).
- The prevalence of essential hypertension (normal urinary albumin excretion) was similar in both groups (3.9% in diabetic patients).
- Type 1 diabetic patients with essential hypertension had higher blood pressure but fewer microangiopathic lesions than those with incipient nephropathy.
Conclusions:
- Hypertension is significantly more prevalent in Type 1 diabetic patients.
- Essential hypertension occurs at similar rates in Type 1 diabetic patients and the general population.
- These findings suggest essential hypertension is unlikely to be the cause of diabetic nephropathy.
Abstract:
The prevalence of hypertension in a representative sample (n = 10202) of the Danish general population aged 16-59 years was assessed to 4.4% based on three blood pressure readings. In Type 1 (insulin-dependent) diabetic patients of similar age (n = 1703) the prevalence was determined in a similar way to 14.7% (p less than 0.00001). The excess prevalence in Type 1 diabetic patients was due to hypertension in patients with incipient and clinical nephropathy as the prevalence of hypertension among diabetic patients with normal urinary albumin excretion (essential hypertension) was 3.9%, similar to that observed in the general population. The patients with Type 1 diabetes and essential hypertension had higher systolic (146 +/- 19 vs 133 +/- 18 mm Hg, p less than 0.00001) and diastolic blood pressure (87 +/- 12 vs 79 +/- 7 mm Hg, p less than 0.00001), but less changes in the eye background than patients with incipient nephropathy (urinary albumin excretion 30-300 mg/24 h) (p less than 0.03), indicating that the two groups were also different with respect to other microangiopathic lesions. Patients with essential hypertension were defined as having a normal urinary albumin excretion before and during antihypertensive treatment (if any). They were followed-up for a 58 (6-234) month period. We confirmed that hypertension is more common among Type 1 diabetic patients than in the general population and found the prevalence of essential hypertension similar in Type 1 diabetic patients to the non-diabetic population. This supports our hypothesis that hypertension is very unlikely to be the cause of diabetic nephropathy.