Adverse Prognostic Significance of New Diabetes in Treated Hypertensive Subjects

• Published in: Hypertension (Dallas, Tex. 1979) Vol. 43; no. 5; pp. 963 - 969
• Main Authors: Verdecchia, Paolo, Reboldi, Gianpaolo, Angeli, Fabio, Borgioni, Claudia, Gattobigio, Roberto, Filippucci, Lucia, Norgiolini, Silvia, Bracco, Costanza, Porcellati, Carlo
• Format: Journal Article
• Language: English
• Published: United States American Heart Association, Inc 01.05.2004
• Subjects: Adrenergic beta-Antagonists - adverse effects; Adrenergic beta-Antagonists - therapeutic use; Adult; Antihypertensive Agents - adverse effects; Antihypertensive Agents - classification; Antihypertensive Agents - therapeutic use; Blood Pressure Monitoring, Ambulatory; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - etiology; Cohort Studies; Diabetes Mellitus, Type 2 - chemically induced; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - epidemiology; Disease-Free Survival; Diuretics - adverse effects; Diuretics - therapeutic use; Electrocardiography; Female; Follow-Up Studies; Humans; Hypertension - complications; Hypertension - drug therapy; Hypertrophy, Left Ventricular - complications; Incidence; Life Tables; Lipids - blood; Male; Middle Aged; Prognosis; Proportional Hazards Models; Risk; Smoking - epidemiology
• ISSN: 0194-911X; 1524-4563; 1524-4563
• DOI: 10.1161/01.HYP.0000125726.92964.ab

ABSTRACT—Diabetes may develop in nondiabetic hypertensive subjects during treatment, but the long-term cardiovascular implications of this phenomenon are not clear. We determined the prognostic value of new diabetes in hypertensive subjects. In a long-term cohort study, 795 initially untreated hypertensive subjects, 6.5% of whom with type 2 diabetes, underwent diagnostic procedures including 24-hour ambulatory blood pressure (BP) monitoring and electrocardiography (ECG). Procedures were repeated after a median of 3.1 years in the absence of cardiovascular events. Follow-up duration was 1 to 16 years (median 6.0). New diabetes occurred in 5.8% of subjects initially without diabetes. Antihypertensive treatment included a diuretic in 53.5% of these subjects, versus 30.4% of those in whom diabetes did not develop (P =0.002). Plasma glucose at entry (P =0.0001) and diuretic treatment on follow-up (P =0.004) were independent predictors of new diabetes. Subsequent to the follow-up visit, a first cardiovascular event occurred in 63 subjects. Event rate in nondiabetic subjects at both visits, new diabetes, and diabetes at entry were 0.97, 3.90, and 4.70×100 person-years, respectively (P =0.0001). After adjustment for several confounders, including 24-hour ambulatory BP, the relative risk of events was 2.92 (95% CI1.33 to 6.41; P =0.007) in the group with new diabetes and 3.57 (95% CI1.65 to 7.73; P =0.001) in the group with previous diabetes, when compared with the group persistently free of diabetes. In treated hypertensive subjects, occurrence of new diabetes portends a risk for subsequent cardiovascular disease that is not dissimilar from that of previously known diabetes.