Prevalence of Hypertension in Type 2 Diabetes Mellitus: Impact of The Tightening Definition of High Blood Pressure and Association With Confounding Risk Factors

The Journal of Cardiometabolic Syndrome (ISSN 1524-6175) is published quarterly by Le Jacq Ltd., Three Parklands Drive, Darien, CT 06820-3652.
Copyright 2006 by Le Jacq Ltd., All rights reserved. No part of this publication may
be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission in writing from the publishers. The
opinions and ideas expressed in this publication are those of the authors and do not necessarily reflect those of the Editors or Publisher. For copies in excess of 25 or for commercial purposes, please contact Sarah Howell at
showell@lejacq.com or 203.656.1711 x106.
ORIGINAL ARTICLE
www.lejacq.com
id: 5513
Prevalence of Hypertension in Type 2 Diabetes Mellitus:

Impact of the Tightening Denition of High Blood Pressure
and Association With Confounding Risk Factors
ver the past decade, there has been

a gradual shift from the perception
that the presence of high blood pressure
(BP) in type 2 diabetes mellitus reects
a mere coincidence of two common
disorders aicting predominantly the
middle-aged and older subjects, to the
recognition that hypertension is a major
modier of the natural course of diabetes and a key culprit in the accelerated
cardiovascular morbidity and mortality
in this disease. This led to the original
recommendation in the Fifth Report
of the Joint National Committee on
Detection, Evaluation, and Treatment of
High Blood Pressure (JNC V) that BP in
diabetic patients be lowered to <130/85
mm Hg.1 Several large multicenter studies subsequently conrmed that both the
relative and absolute benets of hypotensive treatment in preventing coronary
events and stroke were larger in diabetics
than in the rest of the treated hypertensive population.24 Not only was the initial JNC V target BP endorsed by JNC
VI,5 the World Health Organization/
International Society of Hypertension
(WHO/ISH),6 and American Diabetes
Association (ADA) reports,7 but the
Seventh Report of the Joint National
Committee on the Prevention.
Detection, Evaluation, and Treatment
of High Blood Pressure (JNC 7) subsequently recommended further lowering of goal BP to <130/80 mm Hg.8
Although not explicitly stated in some
of these reports, this downward shift in
target BP has inevitably resulted in new
operative denitions of hypertension in
diabetes, i.e., BP 130/85 or 130/80 mm
Hg. Indeed, a recent review suggested
that the latter be used as an indication
for antihypertensive therapy in diabetes,
thereby setting the new threshold level
for denition of hypertension in this
disease at 130/80 mm Hg.9
prevalence of hypertension in diabetes
The Seventh Report of the Joint National Committee on Prevention, Detection,

Evaluation, and Treatment of High Blood Pressure (JNC 7) has recommended a downward shift in target blood pressure to <130/80 mm Hg in diabetic patients, thus
operatively setting a new threshold level for the denition of hypertension at 130/80
mm Hg. The authors performed a retrospective chart analysis of 2227 type 2 diabetes patients treated in one hospital-based and two community-based clinics in central
Israel to determine the prevalence of hypertension as a function of three diagnostic
threshold levels. The prevalence of hypertension in this cohort was 60.2%, 76.5%,
and 85.8% at blood pressure thresholds of 140/90, 130/85, and 130/80 mm Hg,
respectively. Hypertension prevalence increased with age, reaching a rate of 94.4% in
patients aged 80 years or more when the cutoff value of 130/80 mm Hg was used.
At this cutoff, 93.3% and 86.6% of patients with a body mass index over or under
30 kg/m2, respectively, were diagnosed with hypertension. As hypertension appears
to eventually afict the vast majority of diabetic patients, the minority of subjects not
developing hypertension emerges as a unique group, which potentially deserves further
in-depth study. (JCMS. 2006;1:95101) 2006 Le Jacq Ltd.
Emma Kabakov, MD;1 Clara Norymberg, MD;3 Esther Osher, MD;1
Michael Kofer, MD;2 Karen Tordjman, MD;1 Yona Greenman, MD;1 Naftali Stern, MD1
From the Institute of Endocrinology, Metabolism and Hypertension,1 and the
Diabetes Unit,2 Tel Aviv-Sourasky Medical Center and Sackler Faculty of Medicine,
Tel Aviv University, Tel Aviv, Israel; and the Netanya Diabetes Clinic of Kupat Holim
Clalit, Netanya, Israel3
Address for correspondence:
Naftali Stern, MD, Institute of Endocrinology, Metabolism and Hypertension,
Tel Aviv-Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 64239, Israel
E-mail: stern@tasmc.health.gov.il
Manuscript received January 24, 2006; accepted February 8, 2006
The implications of the tightening

denition of high BP in diabetes for the
general care of diabetic patients have
not been thoroughly examined. One
important aspect of this change is that
the fraction of hypertensive subjects in
the diabetes population will inevitably
rise. In the present study, we determined the prevalence of hypertension
as a function of three threshold levels
140/90, 130/85, and 130/80 mm Hg
in 2217 diabetic subjects followed by
three diabetes clinics in central Israel:
one hospital-based referral clinic and
two community-based clinics.
Patients and Methods

Study Population. This study includes
2227 diabetic patients from three dierent cohorts. The rst cohort comprised
all newly diagnosed type 2 diabetic subjects in a regional health maintenance
organization (HMO) diabetes clinic in
the Netanya area (n=667; cohort 1).
According to this HMOs policy, referral to this clinic was mandatory in each
case of newly diagnosed type 2 diabetes.
The second cohort (n=925; cohort
2) comprised patients from another
HMO-run diabetes clinic in a dierent
area in Israel (the city of Givatayim).
JCMS spring 2006
95
The Journal of Cardiometabolic Syndrome (ISSN 1524-6175) is published quarterly by Le Jacq Ltd., Three Parklands Drive, Darien, CT 06820-3652. Copyright 2006 by Le Jacq Ltd., All rights reserved. No part of this publication may
100
90
Percentage
80
70
60
Cohort 1
50
Cohort 2
40
Cohort 3
30
20
10
0
130/80
130/85
140/90
Blood pressure cutoff (mm Hg)
Figure 1. Prevalence of hypertension in diabetes according to cohorts: cohort 1 (n=625), cohort 2 (n=677),
cohort 3 (n=925); p<0.0001 for comparisons among cohorts at all blood pressure levels (N=2227)
100
Prevalence (%)
80
60
Blood pressure (mm Hg)
40
130 /80 (p<0.001)

130 /85 (p<0.001)
20
140 /90 (p<0.001)

0
2130
(n= 20)
3140
(n= 83)
4150
(n= 339)
5160
(n= 541)
6170
(n= 758)
7180
(n= 400)
8190
(n= 77)
Age (years)
Figure 2. Prevalence of hypertension in diabetes as a function of age (n=2218), as dened by

three dierent cut-o values
Referral to this clinic was based on

the primary care physicians assessment,
and no particular general criteria were
applied in the referral process. Finally,
the last cohort (n=625; cohort 3),
comprised patients from the diabetes
clinic of the Tel Aviv-Sourasky Medical
Center, a major referral center in the
metropolitan Tel Aviv area.
Subjects were interviewed and medical history, smoking habits, family history
of diabetes, and all details concerning
past and current medical treatment were
96
recorded. Patients were examined for BP,

weight, and height, such that body mass
index (BMI) could be calculated as well.
Laboratory analysis included total serum
cholesterol, low-density lipoprotein
(LDL) cholesterol, triglycerides, highdensity lipoprotein (HDL) cholesterol,
serum glucose, glycosylated hemoglobin,
and serum creatinine. Data were collected during the patients rst visit to the
clinic. The following criteria were applied
for inclusion in this study: satisfactory admission notes including medical
history, physical examination, and baseline laboratory including at least fasting

glucose and/or glycosylated hemoglobin,
unequivocal evidence of diabetes mellitus, absence of evidence suggestive of
type 1 diabetes or diabetes secondary to
endocrinopathy, and clear documentation of pretreatment BP as recorded in
the patients chart by one of the authors
participating in this survey. Although retrospective in nature, this analysis is based
on a similar practice of BP measurement
conrmed by the participating authors,
which includes the use of sphygmomanometry following 5 minutes in the sitting position, on three separate occasions,
with an average of two measurements
recorded for each visit.
Denitions. The presence of hypertension was dened for the entire patient
population according to three dierent
criteria: 1) the classic criterion of hypertension used in the general population,
i.e., BP 140/90 mm Hg; 2) the criterion used for the denition of hypertension during the years 19932000, i.e.,
BP 130/85 mm Hg; and 3) the new
cuto levels applied for the detection
of hypertension in diabetes as of the
year 2000, i.e., BP 130/80 mm Hg.
Abnormal renal function (chronic
renal failure) was dened as serum
creatinine >1.4 mg/dL in men or >1.2
mg/dL in women.10
Statistical Methods. Comparison
among hypertension rates according to
the dierent criteria was done by analysis of variance with repeated measurements. The relation between gender,
smoking, and family history of diabetes
on the one hand, and presence of hypertension on the other hand, was assessed
by the chi-square test. To analyze the
independent inuence of each factor on
hypertension, all signicant correlations
were further introduced into a model of
logistic regression. In this analysis, the
dependent variable in the regression was
the presence of hypertension, whereas
all the background variants and the
laboratory measurements taken at the
beginning of follow-up constituted the
explaining variables.
JCMS spring 2006
Table I. Demographic, Clinical, and Biochemical Characteristics of the Study Group

TOTAL
COHORT 1
COHORT 2
PARAMETER (MEAN SD)
No. of patients
2227
625
677
Male/female
1164/1063
347/278
379/298
Number
52.3/47.7
55.5/44.5
56.0/44
Percent
60.512.2
61.412.4
61.413.6
Age (yr)
140.822.1
148.725.2
138.522.5
Systolic BP (mm Hg)
Diastolic BP (mm Hg)
81.710.7
86.611.6
78.611.6
77.314.6
79.216.1
78.314.9
Weight (kg)
162.09.7
164.010
167.18.7
Height (cm)
Body mass index (kg/m2)
29.35.0
29.85.7
28.34.9
222.048.5
227.554.6
214.345.1
Total cholesterol (mg/dL)
133.939.7
142.540.5
130.738.9
LDL cholesterol (mg/dL)
45.714.2
46.814.2
45.214.1
HDL cholesterol (mg/dL)
Triglycerides (mg/dL)
197.4156.28
215.2155.2
211.7187.1
0.960.35
1.050.3
0.910.38
Creatinine (mg/dL)
Glycosylated hemoglobin (%)
9.332.74
9.963.22
9.092.48
BP=blood pressure; LDL=low-density lipoprotein; HDL=high-density lipoprotein
Results
438/487
47.4/52.6
60.410
137.117.8
80.78
75.613.2
161.29.5
29.14.8
228.047.9
N/A
N/A
173.7110.3
0.980.29
N/A
VALUE
0.15
<0.0001
<0.0001
<0.0001
<0.0001
0.0987
<0.0001
0.0004
0.2243
<0.0001
<0.0001
0.0004
100
90
Prevalence (%)
Demographic, clinical, and biochemical

characteristics of the study groups are
detailed in Table I. According to classic
criteria for hypertension dened as BP
140/90 mm Hg, the prevalence of hypertension in the entire 2227 diabetic patients
was 60.2%. Expectedly, decreasing the
upper limit of the normal range of BP
resulted in a higher percentage of subjects
classied as hypertensive. Hence, 76.5%
and 85.8% of the entire study population
had BP levels equal to or higher than
130/85 and 130/80 mm Hg, respectively.
Figure 1 depicts the breakdown of the
prevalence of hypertension in the three
cohorts according to the new criteria. Not
surprisingly, the prevalence of hypertension as dened at the three dierent levels
was higher in patients from cohort 3 (the
referral center), reaching 92% in comparison to 87% and 78.3% in cohorts 2
and 1, respectively (p<0.0001), when the
cuto level for dening hypertension was
set at 130/80 mm Hg (Figure 1).
As shown in Figure 2, the prevalence
of hypertension clearly increased with
age. For example, applying the current
criteria for hypertension in diabetes, i.e.,
BP levels 130/80 mm Hg, the derived
rates of hypertension were 62.7% among
patients between the ages of 31 and
40 years, 79.4% for ages 4150 years,
COHORT 3
925
80
70
**
60
Female
50
Male
40
30
20
10
0
130/80
130 /85
140 /90
Blood pressure cutoff (mm Hg)
Figure 3. Prevalence of hypertension in diabetes according to gender; 1063 women; 1164 men.
*p=0.006; **p=0.002
85.4% for ages 6070 years, and 91.0%

for people aged 7180 years. The prevalence of hypertension in the oldest
group, comprising subjects aged 80 years
or older, was 94.4% (Figure 2).
The prevalence of high BP was
generally somewhat higher in diabetic
women than in diabetic men (Figure 3).
However, when current cuto BP levels
(130/80 mm Hg) were applied to
dene hypertension, the gender-related
dierence in the rate of hypertension
was no longer detectable.
Of note also is the relation between

weight and the prevalence of high BP
in this survey. First, the prevalence
of hypertension was higher in subjects whose BMI exceeded 30 kg/m2,
regardless of the particular criteria by
which high BP was dened: 69.7%,
84.5%, and 93.3% of patients with
BMI >30 kg/m2 (n=466) were hypertensive according to cuto values at
140/90, 130/85 and 130/80 mm Hg,
respectively, as opposed to a prevalence of 56.8%, 76.1%, and 86.6% in
JCMS spring 2006
97
100
Prevalence (%)
80
60
40
130/80 (p<0.001)
130/85 (p<0.001)
20
140/90 (p<0.001)
25 (n=237)
2530 (n=547)
3035 (n=335)
>35 (n=131)
BMI (kg/m2 )
100
Prevalence (%)
80
60
40
130/80 (p=0.013)
130/85 (p=0.055)
20
140/90 (p=0.002)
0
25.0 (n=147)
25.130.0 (n=305)
30.135.0 (n=135)
>35.0 (n=39)
BMI (kg/m2 )
100
Prevalence (%)
80
60
40
130/80 (p=0.021)
130/85 (p=0.011)
20
140/90 (p=0.12)
0
25.0 (n=90)
25.130.0 (n=242)
30.135.0 (n=200)
>35.0 (n=92)
BMI (kg/m2)
Figure 4. A) Prevalence of hypertension in diabetes according to body mass index (BMI)

(n=1250); B) Prevalence of hypertension in diabetes according to body mass index (BMI), men
only (n=624); C) Prevalence of hypertension in diabetes according to body mass index (BMI),
women only (n=626), in each case as dened by three dierent cuto values
98
patients with BMI <30 kg/m2 (n=784)

using the same denitions for hypertension (p<0.0001 for all comparisons).
Furthermore, we found a direct and
highly signicant correlation between
the degree of obesity (according to BMI
groups) and the prevalence of hypertension (Figure 4a). For example, while the
prevalence of hypertension (130/80
mm Hg) in type 2 diabetics with BMI
<25 kg/m2 was 82%, the presence
of hypertension was nearly universal
among diabetic subjects with morbid
obesity. Finally, the relation between the
severity of obesity and the prevalence of
hypertension was maintained among
diabetic women as well as men. This
relationship may be somewhat genderspecic, as the prevalence of high BP
appears to rise with increasing obesity
in men, whereas women in the highest BMI group (>35 kg/m2) exhibit
a somewhat lower rate of hypertension than women with BMI of 3035
kg/m2 (Figures 4b and 4c). There was
no relation between the prevalence of
hypertension according to the dierent
diagnostic thresholds and the degree of
glycemic control (not shown).
A clear relation was found between
the presence of increased serum creatinine and the prevalence of hypertension. For example, the rate of hypertension (BP 130/80 mm Hg) was 96%
among subjects with chronic renal failure
(dened by serum creatinine 1.4 mg/
dL; n=74) as opposed to 85% among
diabetic patients with preserved kidney function (n=1873; p=0.006) (Table
II). When hypertension was dened as
130/85 mm Hg, 90.5% of patients
suering from kidney failure were found
to be hypertensive as well, whereas the
prevalence of hypertension was only
75.4% in the group having a normal
creatinine level. Even if hypertension
was dened according to the pre-1993
criterion (BP 140/90 mm Hg), the
prevalence of hypertension was 73%
among patients with clear renal impairment, compared with a rate of 58% in
subjects presumed to have normal kidney function (p<0.01) (Table II). Since
serum creatinine is gender dependent,
the relation between renal disease and
JCMS spring 2006
hypertension can be further delineated

by applying gender-related criteria to the
denition of chronic renal failure, i.e.,
serum creatinine 1.4 mg/dL in men and
1.2 mg/dL in women. If hypertension
is dened by the cuto levels of 130/80
mm Hg, then the rate of high BP is 93%
among diabetic patients with impaired
renal function (n=114), compared with
85% among those having preserved kidney function (n=1833; p=0.018). Similar
relationships also existed when the looser
criteria for the denition of high BP
were applied.
We also identied an association
between presence of hypertension and
serum lipid levels (Table II). As shown,
hypertension, as dened by any of the
these cuto levels was more common
in the presence of hypertriglyceridemia
(serum triglycerides 150 mg/dL). A
similar trend was found in relation to
increased serum levels of total cholesterol (200 mg/dL) and increased
serum LDL cholesterol (100 mg/dL).
For example, the prevalence of hypertension dened as BP 130/80 mm Hg
was 86% among subjects with LDL
cholesterol 100 mg/dL compared
with 73.7% in subjects with lower
serum LDL cholesterol concentrations
(p<0.0001). An inverted association
was found between HDL cholesterol
level and the presence of hypertension
when the latter was dened by the
strictest criteria: the prevalence of BP
130/80 mm Hg was 86.5% among
diabetic patients with low HDL cholesterol (under 45 mg/dL) compared with
81.7% in patients with normal HDL
cholesterol levels (p=0.035) (Table II).
Because many of the parameters
associated with increased BP in our
study are clearly related to each other,
we performed logistic regression analyses of factors related to the presence of
hypertension as dened by the three
dierent cuto values (Table III). All
factors directly related to the presence
of hypertension were considered for
these analyses, but only age, gender, and
BMI appeared consistently related to
hypertension by all three sets of criteria.
As shown, the probability of having
hypertension increased by 3.1%3.8%
Table II. Association of Hypertension With Coexisting Individual Risk Factors for
Cardiovascular Disease
BLOOD PRESSURE CUTOFF (MM HG)

RISK FACTOR (%)
130/80
130/85
140/90
Creatinine
>1.4mg/dL
96
90.5
73
85
75.4
58
<1.4 mg/dL
p value
0.006
0.003
0.01
Triglycerides
88.5
78.8
61.1
>150 mg/dL
84.2
74.8
56.4
<150 mg/dL
p value
0.02
0.005
0.035
Total cholesterol
87
78.1
61.3
>200 mg/dL
82.8
72
54
<200 mg/dL
p value
0.013
0.003
0.002
LDL cholesterol
86.1
77.4
63.2
>100 mg/dL
<100 mg/dL
73.7
68.3
57.5
p value
<0.0001
0.012
0.17
HDL cholesterol
86.5
78
61.8
<45 mg/dL
>45 mg/dL
81.7
74.1
63.4
p value
0.035
0.16
0.61
LDL=low-density lipoprotein; HDL=high-density lipoprotein
per year with advancing age; female

gender signicantly increased the chance
of the presence of hypertension; and
nally, the probability of increased BP
increased by 3.5%4.2% per each BMI
unit (kg/m2), depending on the specic
cuto level used for the denition of
hypertension. All other confounding
factors had no independent eect in
this model.
Discussion
In the present study, we set out to assess

the impact of the tightening denition
of hypertension on the prevalence of
this disease in three cohorts of diabetic
patients. Rather expectedly, the overall
prevalence of hypertension has increased
from 60% to 86% as the threshold for
the denition of high BP has been lowered. Given the estimated prevalence of
hypertension in the general population
and the mean age of our study population (61 years), the prevalence of
hypertension in this survey of diabetic
subjects is some 10%12% higher than
that reported in the general US population based on the second National
N
74
874
1072
918
1342
657
817
167
579
436
Health and Nutrition Examination

Survey (NHANES II) data.11 In accordance with previous reports in the general population,12 the prevalence of
hypertension increased with age and
reached almost 95% among diabetic
patients over the age of 80.
The intercohort dierences in the
prevalence of hypertension are fairly consistent across the various sets of threshold
values used to dene elevated BP in this
study. They likely reect variations in
the prevalence of hypertension in three
dierent clinical settings. The community-based cohort 1, with the lowest
prevalence of hypertension in this survey, likely reects or is at least closely
related to the rate of elevated BP in
diabetic patients soon after the detection
of diabetes mellitus.13 This assumption
appears reasonable, as referral of patients
composing this particular cohort was
mandatory for all newly diagnosed diabetics. Still, some diabetic patients may
have been included in this cohort simply
because they moved into the area or
joined the specic HMO oering the
clinic providing the data to our study.
JCMS spring 2006
99
Table III. Summary of Logistic Regression Analysis of Factors Related to the Presence of Hypertension as Dened by Three Dierent
Cuto Values
BLOOD PRESSURE CUTOFF (MM HG)
130/80
130/85
140/90
P VALUE
ESTIMATE (CI)
P VALUE
ESTIMATE (CI)
P VALUE
FACTOR
ESTIMATE (CI)
Age
1.038
<0.0001
1.032
<0.0001
1.031
<0.0001
(1.0251.051)
(1.0201.045)
(1.0181.044)
0.730
0.022
0.727
<0.0001
0.739
<0.0266
Gender
(0.5580.957)
(0.5560.950)
(0.5650.965)
Body mass
1.035
0.0003
1.042
0.0003
1.039
0.0007
index
(1.0111.059)
(1.0191.065)
(1.0161.062)
1.003
0.9
1.001
0.5
1.000
0.7
Total cholesterol
(1.0001.005)
(0.9981.004)
(0.9981.003)
Triglycerides
1.001
0.09
1.001
0.2
1.001
0.1
(1.0001.002)
(1.0001.002)
(1.0001.002)
1.250
0.3
1.559
0.1
1.507
0.1
Creatinine
(0.8021.950)
(0.9112.668)
(0.8882.558)
CI=95% condence interval
The community-based cohort 2, showing a somewhat higher prevalence of
hypertension, may be more representative of the general diabetic population,
as it included a mixture of recently
diagnosed patients and patients with
longstanding disease requiring the help
of a diabetes specialist. This assessment
should be qualied, however, as one
important limitation of our analysis, in
that we were unable to determine with
certainty the duration of diabetes in the
patients included in this study. Finally,
the hospital-based cohort 3, showing
the highest rate of hypertension, clearly
represents patients who are, on the average, more dicult to control in terms of
glycemia.14 In some cases, uncontrolled
hypertension may have comprised the
real impetus for referral in this cohort,
in addition to uncontrolled diabetes.
Interestingly, we were unable to detect
a consistent link between the tightness
of the glycemic control and the prevalence of hypertension when such analysis
was made directly, based on glycosylated
hemoglobin levels.
Our analysis unravels a link among
several indices of dyslipidemia and the
prevalence of high BP. In the general
population, cardiovascular risk factors
tend to cluster with hypertension.15,16
We are not aware, however, that an
association among elevated arterial pressure and high total and LDL cholesterol
100
has been previously reported in diabetic

subjects. Notably, total cholesterol differs little between diabetic subjects and
controls, such that the segregation of a
higher rate of increased BP with higher
cholesterol levels is not entirely selfevident. Hypertension and low HDL
or/and high triglyceride concentrations,
on the other hand, are known to cosegregate in the metabolic syndrome.17,18
Nephropathy is a dominant and
well established cause for hypertension
among diabetic patients.19 The nding in this study that hypertension is
nearly universal (prevalence of 96%)
in subjects with signicantly impaired
renal function (creatinine >1.4 mg/dL)
is in accord with the presumed role of
renal disease in diabetic hypertension.
In this respect, our data are similar to
recent analyses by Bakris et al.,20 who
noted that the prevalence of hypertension among diabetic patients with evidence of nephropathy exceeded 85%.
Our survey suggests, however, that a
signicant fraction of the hypertension
associated with impaired renal function
is mild: if threshold levels of 140/90
mm Hg rather than 130/80 mm Hg
dene hypertension, the observed rate
of hypertensive subjects among diabetics with creatinine levels 1.4 mg/dL
drops from 96% to 73%.
Among diabetic patients, obesity is a
predictor of subsequent cardiovascular
disease.21,22 Obesity is also a recognized

factor in the pathogenesis of hypertension in general, but its eect on the
presence of hypertension in diabetic
subjects has not been directly addressed
in previous studies. In the present analysis, we show a clear correlation between
BMI and the prevalence of hypertension
in patients with diabetes. We also note
sexual dimorphism in this relationship,
such that the prevalence rises continuously with BMI in men, but appears
to level o and perhaps even decline
in women at the highest BMI range.
It is particularly impressive that while
the overall prevalence of hypertension
appears to be higher in diabetic female
subjects in the present study as well as
in previous reports,23 the prevalence of
hypertension approaches 100% in obese
diabetic men with BMI 35 kg/m2, but
is only 92% in women in the same
BMI range.
As hypertension appears to eventually aict the vast majority of diabetic patients, the minority of diabetic
patients not developing hypertension
emerges as a unique group, which potentially deserves further in-depth study.
This diabetic normotensive phenotype,
apparently immune to the evolution of
hypertension, may be important to characterize in greater detail, both clinically
and genetically, as it may provide clues to
better vascular protection in diabetes.
JCMS spring 2006
REFERENCES
1 The fth report of the Joint National

Committee on Detection, Evaluation, and
Treatment of High Blood Pressure (JNC V).
Arch Intern Med. 1993;153:154183.
2 Curb JD, Pressel SL, Cutler JA, et al. Eect
of diuretic-based antihypertensive treatment
on cardiovascular disease risk in older diabetic patients with isolated systolic hypertension: Systolic Hypertension in the Elderly
Program Cooperative Research Group. JAMA.
1996;276:18861892.
3 Hansson L, Zanchetti A, Carruthers SG, et al.
Eects of intensive blood-pressure lowering
and low-dose aspirin on patients with hypertension: principal results of the Hypertension
Optimal Treatment (HOT) randomized trial.
Lancet. 1998;351:17551762.
4 Heart Outcomes Prevention Evaluation Study
Investigators. Eects of ramipril on cardiovascular and microvascular outcomes in people
with diabetes mellitus: results of the HOPE
study and MICRO-HOPE substudy. Lancet.
2000;355:253259.
5 The sixth report of the Joint National
Committee on prevention, detection, evaluation, and treatment of high blood pressure [published correction appears in Arch
Intern Med. 1998;158:573]. Arch Intern Med.
1997;157:24132446.
6 Guidelines Subcommittee. World Health
Organization-International
Society
of
Hypertension guidelines for the management of
hypertension. J Hypertens. 1999;17:151183.
7 American Diabetes Association. Hypertension
management in adults with diabetes (position state-
ment). Diabetes Care. 2004;27(suppl 1):S65S67.

8 The Seventh Report of the Joint National
Committee on the Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure:
the JNC 7 report. JAMA. 2003;289:25602572.
9 Bakris GL. The importance of blood pressure
control in patients with diabetes. Am J Med.
2004;116:30s38s.
10 K/DOQI clinical practice guidelines for
chronic kidney disease: evaluation, classication, and stratication. Am J Kidney Dis.
2002;29(2 suppl 1):S1S266.
11 Mokdad AH, Ford ES, Bowman BA, et al.
Diabetes trends in the U.S.: 19901998.
Diabetes Care. 2000;23:12781283.
12 Vasan RS, Beiser A, Seshadri S, et al. Residual
lifetime risk for developing hypertension in
middle-aged women and men: the Framingham
Heart Study. JAMA. 2002;287:10031010.
13 Arauz-Pacheco C, Parrott MA, Raskin P. The
treatment of hypertension in adult patients with
diabetes. Diabetes Care. 2002;25:134147.
14 McFarlane SI, Jacober SJ, Winer N, et al.
Control of cardiovascular risk factors in
patients with diabetes and hypertension at
urban academic medical centers. Diabetes
Care. 2002;25:718723.
15 Stamler J, Vaccaro O, Neaton JD, et al.
Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in
the Multiple Risk Factor Intervention Trial.
Diabetes Care. 1993;16:434444.
16 Turner RC, Millns H, Neil HA, et al., for the
United Kingdom Prospective Diabetes Study
Group. Risk factors for coronary artery disease in
17
18
19
20
21
22
23
non-insulin dependent diabetes mellitus: United

Kingdom Prospective Diabetes Study Group
(UKPDS: 23). BMJ. 1998;316:823828.
Mensah GA, Mokdad AH, Deedwania PC, et al.
Obesity, metabolic syndrome, and type 2 diabetes: emerging epidemics and their cardiovascular
implications. Cardiol Clin. 2004;22:485504.
West KM, Ahuja MM, Bennett PH, et al.
The role of circulating glucose and triglyceride concentration and their interaction with
other risk factors as determinants of arterial
disease in nine diabetic population samples
from WHO multinational study. Diabetes
Care. 1983;6:361369.
Ritz E, Orth SR. Nephropathy in patients
with type 2 diabetes mellitus. N Engl J Med.
1999;341:11271133.
Bakris GL, Williams M, Dworkin L, et al.
Preserving renal function in adults with hypertension and diabetes: a consensus approach.
National Kidney Foundation Hypertension
and Diabetes Executive Committees Working
Group. Am J Kidney Dis. 2000;36:646661.
Creager MA, Luscher TF, Consentino F, et al.
Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: part I. Circulation. 2003;108:15271532.
Mokdad AH, Bowman BA, Ford ES, et al. The
continuing epidemic of obesity and diabetes in
the United States. JAMA. 2001;286:11951200.
Pan WH, Cedres LB, Liu K, et al. Relationship
of clinical diabetes and asymptomatic hyperglycemia to risk of coronary heart disease
mortality in men and women. Am J Epidemiol.
1986;123:504516.
JCMS spring 2006
101

Prevalence of Hypertension in Type 2 Diabetes Mellitus: Impact of The Tightening Definition of High Blood Pressure and Association With Confounding Risk Factors

Transféré par

Informations du document

Titre original

Copyright

Formats disponibles

Partager ce document

Partager ou intégrer le document

Options de partage

Avez-vous trouvé ce document utile ?

Ce contenu est-il inapproprié ?

Droits d'auteur :

Formats disponibles

Prevalence of Hypertension in Type 2 Diabetes Mellitus: Impact of The Tightening Definition of High Blood Pressure and Association With Confounding Risk Factors

Transféré par

Droits d'auteur :

Formats disponibles

The Journal of Cardiometabolic Syndrome (ISSN 1524-6175) is published quarterly by Le Jacq Ltd., Three Parklands Drive, Darien, CT 06820-3652.

Prevalence of Hypertension in Type 2 Diabetes Mellitus:

ver the past decade, there has been

The Seventh Report of the Joint National Committee on Prevention, Detection,

The implications of the tightening

Patients and Methods

Blood pressure cutoff (mm Hg)

Blood pressure (mm Hg)

130 /80 (p<0.001)

140 /90 (p<0.001)

Figure 2. Prevalence of hypertension in diabetes as a function of age (n=2218), as dened by

Referral to this clinic was based on

prevalence of hypertension in diabetes

recorded. Patients were examined for BP,

history, physical examination, and baseline laboratory including at least fasting

Table I. Demographic, Clinical, and Biochemical Characteristics of the Study Group

prevalence of hypertension in diabetes

Demographic, clinical, and biochemical

85.4% for ages 6070 years, and 91.0%

Of note also is the relation between

Blood pressure (mm Hg)

Blood pressure (mm Hg)

Blood pressure (mm Hg)

Figure 4. A) Prevalence of hypertension in diabetes according to body mass index (BMI)

prevalence of hypertension in diabetes

patients with BMI <30 kg/m2 (n=784)

hypertension can be further delineated

BLOOD PRESSURE CUTOFF (MM HG)

per year with advancing age; female

In the present study, we set out to assess

Health and Nutrition Examination

prevalence of hypertension in diabetes

has been previously reported in diabetic

disease.21,22 Obesity is also a recognized

JCMS spring 2006

1 The fth report of the Joint National

prevalence of hypertension in diabetes

ment). Diabetes Care. 2004;27(suppl 1):S65S67.

non-insulin dependent diabetes mellitus: United

JCMS spring 2006

Vous aimerez peut-être aussi