Hypertensive target organ damage predicts incident diabetes mellitus

Eur Heart J. 2013 Nov;34(44):3419-26. doi: 10.1093/eurheartj/eht281. Epub 2013 Jul 23.

Abstract

Aims: Whether patients with hypertensive preclinical cardiovascular disease (CVD) are at higher risk of incident diabetes has never been studied.

Methods and results: We assessed incident diabetes in 4176 hypertensive non-diabetic patients (age 58.7 ± 8.9 years, 58% male) with ≥1 year follow-up (median: 3.57 years; inter-quartile range: 2.04-7.25). Left ventricular (LV) hypertrophy (LVH) was defined as LV mass index (LVMi) ≥51 g/m(2.7). Carotid atherosclerosis (CA) was defined as intima-media thickness >1.5 mm. During follow-up, diabetes developed in 393 patients (9.4%), more frequently in those with than without initial LVH or CA (odds ratio = 1.97 and 1.67, respectively; both P < 0.0001). In the Cox regression, the presence of either initial LVH or CA was associated with higher hazard of diabetes [hazards ratio (HR) = 1.30 and 1.38, respectively; both P = 0.03], independently of the type and number of anti-hypertensive medications, initial systolic blood pressure (P < 0.001), body mass index, fasting glucose, family history of diabetes (all P < 0.0001), and therapy with β-blockers. The presence of one of the, or both, markers of preclinical CVD increased the chance of incident diabetes by 63 or 64%, respectively (both P < 0.002), independently of significant confounders, a result that was confirmed (HR = 1.70 or 1.93, respectively; both P < 0.0001) using ATPIII metabolic syndrome (HR = 2.73; P < 0.0001) in the Cox model.

Conclusion: Initial LVH and CA are significant predictors of new onset diabetes in a large population of treated hypertensive patients, independently of initial metabolic profile, anti-hypertensive therapy, and other significant covariates. This sequence may be attributable to risk factors common to preclinical CVD and diabetes, but a vascular origin of diabetes cannot be excluded.

Keywords: Diabetes; Hypertension; Metabolic syndrome; Target organ damage.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Body Mass Index
  • Carotid Artery Diseases / complications
  • Carotid Intima-Media Thickness
  • Diabetes Mellitus, Type 2 / diagnosis
  • Diabetes Mellitus, Type 2 / etiology*
  • Diabetic Angiopathies / diagnosis
  • Diabetic Angiopathies / etiology*
  • Female
  • Humans
  • Hypertension / complications*
  • Hypertrophy, Left Ventricular / complications
  • Incidental Findings
  • Male
  • Metabolic Syndrome / etiology
  • Middle Aged
  • Obesity / complications
  • Regression Analysis
  • Risk Factors