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Si Y, Wang A, Yang Y, Liu H, Gu S, Mu Y, Lyu Z. Fasting Blood Glucose and 2-h Postprandial Blood Glucose Predict Hypertension: A Report from the REACTION Study. Diabetes Ther 2021; 12:1117-1128. [PMID: 33660197 PMCID: PMC7994488 DOI: 10.1007/s13300-021-01019-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/30/2021] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Although diabetes is associated with hypertension, whether high blood glucose levels promote hypertension remains controversial. In this study we compared the predictive power of fasting plasma glucose (FPG), 2-h postprandial blood glucose (2hPG), and glycated hemoglobin (HbA1c) for the development of hypertension. METHODS This study was a substudy of the REACTION study, an ongoing longitudinal cohort study investigating the relationship of prediabetes and type 2 diabetes with the risk of cancer in an urban Northern Chinese population in Beijing. Logistic regression analysis was used to calculate odds ratios (ORs) after adjustment for risk factors for hypertension, including age, sex, body mass index, and triglycerides. RESULTS Among the 3437 participants, 497 developed hypertension during the 4-year follow-up. The logistic regression analysis showed that elevated FPG and 2hPG levels (FPG: OR 1.529; 95% confidence interval [CI] 1.348-1.735; 2hPG: OR 1.144; 95% CI 1.100-1.191), but not HbA1c, were independent risk factors for the development of hypertension. In the highest quartile of FPG and 2hPG levels, the multivariable-corrected ORs were 2.115 (95% CI 1.612-2.777) and 2.346 (95% CI 1.787-3.080), respectively, compared with the lowest quartile. The adjusted models showed no significant correlations between quartile HbA1c levels and the development of hypertension. CONCLUSION Higher FPG and 2hPG levels, but not HbA1c levels, are independent risk factors for developing hypertension in an urban Northern Chinese population. TRIAL REGISTRATION ClinicalTrials.gov NCT01206869.
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Affiliation(s)
- Yingkui Si
- Department of Endocrinology, Chinese PLA General Hospital, Beijing, China
- Department of Endocrinology, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
| | - Anping Wang
- Department of Endocrinology, Chinese PLA General Hospital, Beijing, China
| | - Yunshuang Yang
- Department of Preventive Medicine, Beijing Longfu Hospital, Beijng, China
| | - Hongzhou Liu
- Department of Endocrinology, Chinese PLA General Hospital, Beijing, China
| | - Shi Gu
- Department of Endocrinology, The First People's Hospital of Shuangliu District, Chengdu, China
| | - Yiming Mu
- Department of Endocrinology, Chinese PLA General Hospital, Beijing, China.
| | - Zhaohui Lyu
- Department of Endocrinology, Chinese PLA General Hospital, Beijing, China.
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2
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Sasaki N, Ozono R, Maeda R, Higashi Y. Risk of hypertension in middle-aged and elderly participants with newly diagnosed type 2 diabetes and prediabetes. BMJ Open Diabetes Res Care 2020; 8:8/1/e001500. [PMID: 32933951 PMCID: PMC7493116 DOI: 10.1136/bmjdrc-2020-001500] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/02/2020] [Accepted: 07/30/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Little is known about the risk of hypertension in patients with the early stage of type 2 diabetes. We investigated the risk of hypertension in participants with newly diagnosed type 2 diabetes and prediabetes. RESEARCH DESIGN AND METHODS This is a retrospective cohort study consisting of 2136 middle-aged participants (1022 with normal fasting glucose/normal glucose tolerance (NFG/NGT), 418 with impaired fasting glucose (IFG), 466 with impaired glucose tolerance (IGT) and 230 with diabetes) and 3426 elderly participants (1762 with NFG/NGT, 599 with IFG, 781 with IGT, and 284 with diabetes). All participants underwent 75 g oral glucose tolerance tests at baseline. RESULTS Over a median 59-month follow-up period, 459 middle-aged and 1170 elderly participants developed hypertension. In middle-aged participants, the odds of incident hypertension were significantly higher in those with IFG (OR 1.40; p=0.019), IGT (OR 1.49; p=0.004), and diabetes (OR 1.55; p=0.013) than those with NFG/NGT, which was no longer significant after adjustment for body mass index. Subgroup analysis showed that the risk of hypertension was significantly higher in diabetes than NFG/NGT only in participants without obesity. Conversely, obesity was a risk factor of hypertension only in those with IFG and NFG/NGT. In elderly participants, there was no difference in the risk of hypertension among the NFG/NGT, IFG, IGT and diabetes groups. CONCLUSIONS The risk of hypertension is modest in participants with newly diagnosed type 2 diabetes and prediabetes. Our findings suggest that the early stages of type 2 diabetes and prediabetes may be a key period for reducing hypertension, given the pronounced risk of hypertension in patients with diabetes reported in previous studies. In terms of reducing the risk for hypertension, obesity treatment might be advantageous in the early stages rather than the advanced stages of impaired glucose metabolism.
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Affiliation(s)
- Nobuo Sasaki
- Health Management and Promotion Center, Hiroshima Atomic Bomb Casualty Council, Hiroshima, Japan
| | - Ryoji Ozono
- Department of General Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Ryo Maeda
- Health Management and Promotion Center, Hiroshima Atomic Bomb Casualty Council, Hiroshima, Japan
| | - Yukihito Higashi
- Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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3
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Geva M, Shlomai G, Berkovich A, Maor E, Leibowitz A, Tenenbaum A, Grossman E. The association between fasting plasma glucose and glycated hemoglobin in the prediabetes range and future development of hypertension. Cardiovasc Diabetol 2019; 18:53. [PMID: 31029146 PMCID: PMC6486972 DOI: 10.1186/s12933-019-0859-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 04/18/2019] [Indexed: 12/16/2022] Open
Abstract
Background Prediabetes is a well-established risk factor for progression to overt diabetes mellitus (DM), which is in turn associated with development of hypertension (HTN) and vice versa. However, the role of prediabetes and HbA1c in particular as an independent risk factor for the development of hypertension is unclear. Aim In this current study, we aimed to evaluate the association between both fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) levels in the prediabetes range and development of HTN among a large cohort of normotensive subjects. Design and methods We investigated 5016 normotensive participants without DM and other cardiovascular risk factors who were annually screened in a tertiary medical center. Subjects were divided into normoglycemic and prediabetic groups. Normoglycemia was defined as HbA1c < 5.7% and FPG < 100 mg/dl. Prediabetes was defined according to the ADA criteria, i.e., 6.5% > HbA1c ≥ 5.7% or impaired fasting glucose (IFG):126 mg/dl > FPG ≥ 100 mg/dl. Subgroup analysis was made by dividing participants into four groups according to FPG and HbA1C levels, i.e., normoglycemia, impaired HbA1c only, IFG only, and both parameters impaired. Results During a follow-up of 3.7 ± 2.9 years, 318 (6.3%) subjects developed HTN. A cumulative hazard function for the development of hypertension showed a 2.89-fold ([95% CI 2.19–3.83], p < .0001) increased risk for HTN in the prediabetic population. In a multivariable Cox proportional hazard regression model adjusted to common confounding risk factors for HTN, prediabetes was found to be independently associated with a 1.95-fold ([95%, CI 1.43–2.52] p < .0001) increased risk for hypertension. Impaired HbA1C only was not found to be independently associated with HTN, while IFG only showed a 2.13-fold (95%, [CI 1.46–3.11] p < .0001) increased risk for HTN compared to normoglycemic, and a 2.55-fold ([95% CI 1.85–3.51] p < .0001) increased risk for HTN when both parameters impaired. Conclusion Our study demonstrates that FPG in the prediabetes range, albeit not glycated hemoglobin, is independently and significantly associated with future development of HTN. Therefore, our findings further highlight the pivotal predictive role of IFG for HTN development as opposed to the limited independent role of abnormal HbA1c levels. Electronic supplementary material The online version of this article (10.1186/s12933-019-0859-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mika Geva
- Department of Internal Medicine D, Chaim Sheba Medical Center, Ramat Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Gadi Shlomai
- Department of Internal Medicine D, Chaim Sheba Medical Center, Ramat Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Anat Berkovich
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel.,Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Elad Maor
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel.,Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Avshalom Leibowitz
- Department of Internal Medicine D, Chaim Sheba Medical Center, Ramat Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Alexander Tenenbaum
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel.,Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Ehud Grossman
- Department of Internal Medicine D, Chaim Sheba Medical Center, Ramat Gan, Israel. .,Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel.
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4
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Lee CJ, Lim NK, Kim HC, Ihm SH, Lee HY, Park HY, Park S. Impaired fasting glucose and impaired glucose tolerance do not predict hypertension: a community cohort study. Am J Hypertens 2015; 28:493-500. [PMID: 25267735 DOI: 10.1093/ajh/hpu186] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Insulin resistance has an important role in the pathogenesis of hypertension. We hypothesized that impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) which represents insulin resistance would predict the development of hypertension. METHODS A total of 4,039 subjects without hypertension or diabetes (1,847 men and 2,192 women; age 49.9±8.2 years), from the Ansan-Ansung cohorts within the Korean Genome Epidemiology Study, were enrolled in 2001-2002 and restudied in 2005-2006. The association between the incidence of hypertension and IFG, IGT, or other metabolic factors was studied. RESULTS During the 4-year follow-up period, 582 of the 4,039 subjects developed hypertension. At baseline, the prevalence of abdominal obesity, dyslipidemia, and IGT was higher in subjects who became hypertensive compared to those that remained normotensive. The prevalence of IFG was not significantly different between the 2 groups. In a multivariate analysis, abdominal obesity and high serum triglyceride were significant risk factors for the development of hypertension. Neither IFG nor IGT were significantly associated with new-onset hypertension. Although the risk of hypertension was higher with the number of metabolic components present at baseline, IFG and IGT were not significant components compared to other metabolic components, especially when abdominal obesity was taken into account. CONCLUSIONS While metabolic syndrome components related to insulin resistance present at baseline are important risk factors of hypertension, we conclude that coexisting metabolic component, mainly abdominal obesity, rather than IFG and IGT have more predictive value for determining the development of hypertension in a Korean population.
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Affiliation(s)
- Chan Joo Lee
- Department of Biochemistry and Molecular Biology, Institute of Genetic Science, Integrated Genomic Research Center for Metabolic Regulation, BK21 PLUS project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Nam-Kyoo Lim
- Division of Cardiovascular and Rare diseases, Center for Biomedical Science, National Institute of Health, Cheongwon-gun, Chungbuk, Korea
| | - Hyeon-Chang Kim
- Department of Preventive medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sang-Hyun Ihm
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hae-Young Lee
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Young Park
- Division of Cardiovascular and Rare diseases, Center for Biomedical Science, National Institute of Health, Cheongwon-gun, Chungbuk, Korea
| | - Sungha Park
- Division of Cardiology, Yonsei Cardiovascular Hospital, Yonsei Cardiovascular Research Institute, Yonsei University of Medicine, Seoul, Korea.
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5
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Glucose and the risk of hypertension in first-degree relatives of patients with type 2 diabetes. Hypertens Res 2015; 38:349-54. [PMID: 25693857 DOI: 10.1038/hr.2015.10] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 12/01/2014] [Accepted: 12/02/2014] [Indexed: 01/14/2023]
Abstract
To test the hypothesis that plasma glucose (PG) levels is associated with the incidence of hypertension (HT) in nondiabetic and non-hypertensive first-degree relatives (FDR) of people with type 2 diabetes (T2D). A total of 1089 FDR without diabetes and/or HT of consecutive patients with T2D 30-70 years old were examined and followed for a mean (s.d.) of 6.9 (1.7) years for HT incidence. At baseline and through follow-up, participants underwent a standard 75 gm 2-h oral glucose tolerance test. HT was defined according to the criteria of the Seventh Report of Joint National Committee. We used Cox proportional hazard models to estimate hazard ratio for incident HT and plotted a receiver operating characteristic curve to assess discrimination. The PG levels at baseline were associated with incidence of HT, independently of age, gender, obesity and high cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, education and systolic blood pressure. Those with impaired glucose tolerance were 54% (hazard ratio 1.54; 95% confidence interval (CI) 1.33, 1.77) more likely to develop HT than those with normal glucose tolerance. Those with impaired fasting glucose were also 23% (hazard ratio 1.23; 95% CI 1.01, 1.50) more likely to develop HT. High PG levels were consistently associated with incident HT.
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6
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Goharian TS, Andersen LB, Franks PW, Wareham NJ, Brage S, Veidebaum T, Ekelund U, Lawlor DA, Loos RJF, Grøntved A. Examining the causal association of fasting glucose with blood pressure in healthy children and adolescents: a Mendelian randomization study employing common genetic variants of fasting glucose. J Hum Hypertens 2014; 29:179-84. [DOI: 10.1038/jhh.2014.63] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 06/14/2014] [Accepted: 06/25/2014] [Indexed: 12/16/2022]
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7
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Petrie JR, Malik MO, Balkau B, Perry CG, Højlund K, Pataky Z, Nolan J, Ferrannini E, Natali A. Euglycemic Clamp Insulin Sensitivity and Longitudinal Systolic Blood Pressure. Hypertension 2013; 62:404-9. [DOI: 10.1161/hypertensionaha.111.00439] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Insulin resistance may be an independent risk factor for the development of hypertension, but change in blood pressure (BP) over time has not been adequately studied in healthy individuals fully characterized for insulin sensitivity. In the Relationship between Insulin Sensitivity and Cardiovascular disease (RISC) study, we measured insulin sensitivity (M/I) using the euglycemic clamp technique in 1073 healthy European adults (587 women, 486 men) aged 30 to 60 years followed up 3 years later. Systolic BP (SBP) at baseline was higher in insulin-resistant women (ie, those in the low sex-specific M/I tertile) compared with those in the intermediate (
P
<0.001) or high tertiles (
P
=0.06; mean±SD: 117±13, 111±12, 114±12 mm Hg, respectively). It did not differ across M/I tertiles in men. After adjustment for age, body mass index, baseline SBP, and other covariates, low insulin sensitivity (M/I) predicted a longitudinal rise in SBP in women but not in men; M/I was not associated with change in diastolic BP. SBP rose over time in both sexes and within all M/I tertiles (
P
<0.05), except in women with high insulin sensitivity. Therefore, in women (but not in men), low insulin sensitivity was associated with higher SBP at 3 years, and high insulin sensitivity was associated with a lower rise in SBP over time.
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Affiliation(s)
- John R. Petrie
- From the University of Glasgow, Glasgow, United Kingdom (J.R.P., M.O.M., C.P.); Khyber Medical University Peshawar, Peshawar, Pakistan (M.O.M); INSERM U1018, Villejuif, France (B.B.); University Paris Sud 11, UMRS 1018, Villejuif, France (B.B.); Odense University Hospital, Odense, Denmark (K.H.); University Hospital of Geneva, Switzerland (Z.P.); Steno Diabetes Center, Copenhagen, Denmark (J.N.); and the Department of Internal Medicine, University of Pisa, Pisa, Italy (E.F., A.N.)
| | - Muhammad Omar Malik
- From the University of Glasgow, Glasgow, United Kingdom (J.R.P., M.O.M., C.P.); Khyber Medical University Peshawar, Peshawar, Pakistan (M.O.M); INSERM U1018, Villejuif, France (B.B.); University Paris Sud 11, UMRS 1018, Villejuif, France (B.B.); Odense University Hospital, Odense, Denmark (K.H.); University Hospital of Geneva, Switzerland (Z.P.); Steno Diabetes Center, Copenhagen, Denmark (J.N.); and the Department of Internal Medicine, University of Pisa, Pisa, Italy (E.F., A.N.)
| | - Beverley Balkau
- From the University of Glasgow, Glasgow, United Kingdom (J.R.P., M.O.M., C.P.); Khyber Medical University Peshawar, Peshawar, Pakistan (M.O.M); INSERM U1018, Villejuif, France (B.B.); University Paris Sud 11, UMRS 1018, Villejuif, France (B.B.); Odense University Hospital, Odense, Denmark (K.H.); University Hospital of Geneva, Switzerland (Z.P.); Steno Diabetes Center, Copenhagen, Denmark (J.N.); and the Department of Internal Medicine, University of Pisa, Pisa, Italy (E.F., A.N.)
| | - Colin G. Perry
- From the University of Glasgow, Glasgow, United Kingdom (J.R.P., M.O.M., C.P.); Khyber Medical University Peshawar, Peshawar, Pakistan (M.O.M); INSERM U1018, Villejuif, France (B.B.); University Paris Sud 11, UMRS 1018, Villejuif, France (B.B.); Odense University Hospital, Odense, Denmark (K.H.); University Hospital of Geneva, Switzerland (Z.P.); Steno Diabetes Center, Copenhagen, Denmark (J.N.); and the Department of Internal Medicine, University of Pisa, Pisa, Italy (E.F., A.N.)
| | - Kurt Højlund
- From the University of Glasgow, Glasgow, United Kingdom (J.R.P., M.O.M., C.P.); Khyber Medical University Peshawar, Peshawar, Pakistan (M.O.M); INSERM U1018, Villejuif, France (B.B.); University Paris Sud 11, UMRS 1018, Villejuif, France (B.B.); Odense University Hospital, Odense, Denmark (K.H.); University Hospital of Geneva, Switzerland (Z.P.); Steno Diabetes Center, Copenhagen, Denmark (J.N.); and the Department of Internal Medicine, University of Pisa, Pisa, Italy (E.F., A.N.)
| | - Zoltan Pataky
- From the University of Glasgow, Glasgow, United Kingdom (J.R.P., M.O.M., C.P.); Khyber Medical University Peshawar, Peshawar, Pakistan (M.O.M); INSERM U1018, Villejuif, France (B.B.); University Paris Sud 11, UMRS 1018, Villejuif, France (B.B.); Odense University Hospital, Odense, Denmark (K.H.); University Hospital of Geneva, Switzerland (Z.P.); Steno Diabetes Center, Copenhagen, Denmark (J.N.); and the Department of Internal Medicine, University of Pisa, Pisa, Italy (E.F., A.N.)
| | - John Nolan
- From the University of Glasgow, Glasgow, United Kingdom (J.R.P., M.O.M., C.P.); Khyber Medical University Peshawar, Peshawar, Pakistan (M.O.M); INSERM U1018, Villejuif, France (B.B.); University Paris Sud 11, UMRS 1018, Villejuif, France (B.B.); Odense University Hospital, Odense, Denmark (K.H.); University Hospital of Geneva, Switzerland (Z.P.); Steno Diabetes Center, Copenhagen, Denmark (J.N.); and the Department of Internal Medicine, University of Pisa, Pisa, Italy (E.F., A.N.)
| | - Ele Ferrannini
- From the University of Glasgow, Glasgow, United Kingdom (J.R.P., M.O.M., C.P.); Khyber Medical University Peshawar, Peshawar, Pakistan (M.O.M); INSERM U1018, Villejuif, France (B.B.); University Paris Sud 11, UMRS 1018, Villejuif, France (B.B.); Odense University Hospital, Odense, Denmark (K.H.); University Hospital of Geneva, Switzerland (Z.P.); Steno Diabetes Center, Copenhagen, Denmark (J.N.); and the Department of Internal Medicine, University of Pisa, Pisa, Italy (E.F., A.N.)
| | - Andrea Natali
- From the University of Glasgow, Glasgow, United Kingdom (J.R.P., M.O.M., C.P.); Khyber Medical University Peshawar, Peshawar, Pakistan (M.O.M); INSERM U1018, Villejuif, France (B.B.); University Paris Sud 11, UMRS 1018, Villejuif, France (B.B.); Odense University Hospital, Odense, Denmark (K.H.); University Hospital of Geneva, Switzerland (Z.P.); Steno Diabetes Center, Copenhagen, Denmark (J.N.); and the Department of Internal Medicine, University of Pisa, Pisa, Italy (E.F., A.N.)
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8
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Bower JK, Appel LJ, Matsushita K, Young JH, Alonso A, Brancati FL, Selvin E. Glycated hemoglobin and risk of hypertension in the atherosclerosis risk in communities study. Diabetes Care 2012; 35:1031-7. [PMID: 22432110 PMCID: PMC3329825 DOI: 10.2337/dc11-2248] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Diabetes and hypertension often co-occur and share risk factors. Hypertension is known to predict diabetes. However, hyperglycemia also may be independently associated with future development of hypertension. We investigated glycated hemoglobin (HbA(1c)) as a predictor of incident hypertension. RESEARCH DESIGN AND METHODS We conducted a prospective analysis of 9,603 middle-aged participants in the Atherosclerosis Risk in Communities Study without hypertension at baseline. Using Cox proportional hazards models, we estimated the association between HbA(1c) at baseline and incident hypertension by two definitions 1) self-reported hypertension during a maximum of 18 years of follow-up and 2) measured blood pressure or hypertension medication use at clinic visits for a maximum of 9 years of follow-up. RESULTS We observed 4,800 self-reported and 1,670 visit-based hypertension cases among those without diagnosed diabetes at baseline. Among those with diagnosed diabetes at baseline, we observed 377 self-reported and 119 visit-based hypertension cases. Higher baseline HbA(1c) was associated with an increased risk of hypertension in subjects with and without diabetes. Compared with nondiabetic adults with HbA(1c) <5.7%, HbA(1c) in the prediabetic range (5.7-6.4%) was independently associated with incident self-reported hypertension (hazard ratio 1.14 [95% CI 1.06-1.23]) and visit-detected hypertension (1.17 [1.03-1.33]). CONCLUSIONS We observed that individuals with elevated HbA(1c), even without a prior diabetes diagnosis, are at increased risk of hypertension. HbA(1c) is a known predictor of incident heart disease and stroke. Our results suggest that the association of HbA(1c) with cardiovascular risk may be partially mediated by the development of hypertension.
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Affiliation(s)
- Julie K Bower
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
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Lai TS, Curhan GC, Forman JP. Insulin resistance and risk of incident hypertension among men. J Clin Hypertens (Greenwich) 2010; 11:483-90. [PMID: 19751460 DOI: 10.1111/j.1751-7176.2009.00160.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
J Clin Hypertens (Greenwich). 2009;11:483-490. (c) 2009 Wiley Periodicals, Inc.The independent association between insulin resistance and the development of hypertension remains in doubt because insulin resistance correlates with other metabolic factors also proposed to be associated with hypertension. The authors examined the association between the insulin sensitivity index and incident hypertension in a prospective nested case-control study among 1453 men (mean age, 61 years) who participated in the Health Professionals' Follow-up Study. The authors computed the insulin sensitivity index for each man in the study based on fasting insulin and triglyceride levels. Logistic regression was performed conditioned on age and adjusted for standard hypertension risk factors as well as renal function, cholesterol, and uric acid. The insulin sensitivity index was 6% lower in the cases compared with the controls (P<.001). The multivariable odds ratio for hypertension comparing the lowest with highest quartile of insulin sensitivity index was 1.09 (0.71-1.65) among the entire sample. However, the association between the insulin sensitivity index and incident hypertension differed significantly by age (P interaction <.001). Among men younger than 60 years, the multivariable odds ratio for the lowest compared with highest quartile was 1.93 (1.01-3.71) but was 0.67 (0.37-1.24) among older men. Insulin resistance is independently associated with incident hypertension among younger men.
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Affiliation(s)
- Tai-Shuan Lai
- Renal Division, National Taiwan University Hospital, Yun-Lin Branch, Yun-lin, Taiwan
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10
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Two-hour glucose predicts the development of hypertension over 5 years: the AusDiab study. J Hum Hypertens 2007; 22:168-76. [DOI: 10.1038/sj.jhh.1002316] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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11
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Arnlöv J, Pencina MJ, Nam BH, Meigs JB, Fox CS, Levy D, D'Agostino RB, Vasan RS. Relations of Insulin Sensitivity to Longitudinal Blood Pressure Tracking. Circulation 2005; 112:1719-27. [PMID: 16157770 DOI: 10.1161/circulationaha.105.535039] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background—
The relations of insulin sensitivity (IS) to hypertension incidence may vary according to baseline age, body mass index (BMI), and blood pressure (BP).
Methods and Results—
We investigated the relations of IS (insulin sensitivity index, ISI
0,120
) to 4-year incidence of hypertension and BP progression in 1933 nonhypertensive Framingham Study participants (median age, 51 years; 56% women). Analyses were stratified by age (less than versus greater than or equal to median), BMI (<25 [normal], 25 to <30 [overweight], ≥30 kg/m
2
[obese]), and BP category (systolic BP≥130 or diastolic BP≥85, “high normal” per the sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High BP [JNC-VI] versus BP<130/85 mm Hg). On follow-up, 41% of participants had BP progression (≥1 BP stage increase) and 18% had development of hypertension (systolic BP≥140 or diastolic BP≥90 mm Hg or antihypertensive medication use). In younger (<51 years) people with normal BMI and baseline BP<130/85 mm Hg, the second-to-fourth ISI
0,120
quartiles were associated with lower multivariable-adjusted odds for hypertension incidence (0.27; 95% CI, 0.09 to 0.83;
P
<0.05) and BP progression (0.37; 95% CI, 0.18 to 0.77;
P
<0.01) relative to the lowest (most insulin resistant) quartile. IS was not related to BP progression or hypertension incidence in older individuals, in obese participants, or in people with BP≥130/85 mm Hg.
Conclusions—
In our large community-based sample, reduced IS predicted BP tracking principally in younger people with normal BMI and BP<130/85 mm Hg. Effect modification by age, BMI, and baseline BP may explain variation in the results of prior clinical investigations relating IS to hypertension incidence.
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Affiliation(s)
- Johan Arnlöv
- Framingham Heart Study, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
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12
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Abstract
A number of children and adolescents are at risk for complications and comorbidities of type 2 diabetes, prediabetes, or metabolic syndrome. These complications and comorbidities are likely to present significant personal burdens and societal costs. The pediatrician should be aware of screening and interventions to lessen the effect of these risks on their patients. Societal-wide lifestyle changes are needed desperately to reduce the prevalence of these largely preventable diseases.
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