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Treated hypertensive subjects who develop diabetes may have increased risk of CVD similar to that of treated hypertensive patients with established diabetes, data show
Treated hypertensive subjects who develop diabetes may have increased risk of CVD similar to that of treated hypertensive patients with established diabetes, data show -- Posted by Gumbo on 10-24-04 14:42
ADA Comments:
New data suggested that patients with new-onset diabetes being treated for
hypertension and those with a previous diagnosis of diabetes were 3 times
more likely to have subsequent cardiovascular disease over a long-term
follow-up period than treated hypertensive subjects who remained free of
diabetes. Initially, 795 hypertensive subjects, 51 with type 2 diabetes,
whose hypertension was untreated before study entry underwent a series of
diagnostic procedures at baseline including 24-hour blood pressure (BP)
monitoring and electrocardiography (ECG). In the absence of cardiovascular
events, the same procedures were performed again after a median of 3.1
years. During a mean follow-up of
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Treated hypertensive subjects who develop diabetes may have increased risk
of CVD similar to that of treated hypertensive patients with established
diabetes, data show
New data suggested that patients with new-onset diabetes being treated for
hypertension and those with a previous diagnosis of diabetes were 3 times
more likely to have subsequent cardiovascular disease over a long-term
follow-up period than treated hypertensive subjects who remained free of
diabetes.
Initially, 795 hypertensive subjects, 51 with type 2 diabetes, whose
hypertension was untreated before study entry underwent a series of
diagnostic procedures at baseline including 24-hour blood pressure (BP)
monitoring and electrocardiography (ECG). In the absence of cardiovascular
events, the same procedures were performed again after a median of 3.1
years.
During a mean follow-up of 6 years, new diabetes occurred in 5.8% (nC) of
the subjects.
At baseline and at the follow-up visit, subjects who developed new diabetes
had more elevated 24-hour ambulatory systolic and diastolic BP, a greater
prevalence of left ventricular hypertrophy, and increased glucose levels
(all P<.05) compared with subjects who remained free of diabetes.
Among those with new diabetes, 53.5% received hypertensive treatment with a
diuretic, whereas 30.4% of patients who did not develop diabetes were
treated with a diuretic (P<.002).
Logistic regression analysis revealed that plasma glucose concentrations at
baseline and diuretic treatment at follow-up were the sole independent
predictors of new-onset diabetes (P<.0001 and P=.004, respectively).
After the follow-up visit, a first cardiovascular event occurred in 63
subjects. The event rate in nondiabetic subjects at both visits was 0.97 per
100 person-years, while the event rate for subjects with new diabetes was
3.90 per 100 person-years, and the event rate for those with diabetes at
study entry was 4.70 per 100 person-years (P=.0001).
After adjusting for confounding factors such as 24-hour ambulatory BP, the
relative risk of cardiovascular events was 2.92 in the group with new
diabetes (95% CI, 1.33-6.41; P=.007) and 3.57 in the group with established
diabetes (95% CI, 1.65-7.73; P=.001), when compared with subjects who
remained free of diabetes. For each 1.58 mmol/L increase in serum glucose at
the follow-up visit, the independent risk of cardiovascular events increased
by 23% (95% CI, 4-46; P=.013).
The authors noted it was important to remark that the occurrence of new
diabetes was an independent predictor of cardiovascular risk, whereas the
use of diuretics, albeit predictive of new diabetes, did not show any
independent relation with the subsequent cardiovascular events.
Hypertensive subjects with plasma glucose in the high-normal range and those
treated with diuretics should be monitored with care to prevent occurrence
of new diabetes, the research team concluded. (Verdecchia P, et al.
Hypertension 2004;43:1-7.)
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