Contrasting mortality risks among subgroups of treated hypertensive patients developing new-onset diabetes

Lip, S., Jeemon, P., Mccallum, L., Dominiczak, A. F. , McInnes, G. T. and Padmanabhan, S. (2016) Contrasting mortality risks among subgroups of treated hypertensive patients developing new-onset diabetes. European Heart Journal, 374(12), (doi:10.1093/eurheartj/ehv557) (PMID:26508167)

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Abstract

Aims: Hypertension and diabetes mellitus (DM) frequently cluster together and synergistically increase cardiovascular risk. Among those who develop DM during treatment for hypertension (new-onset diabetes, NOD), it is unclear whether NOD reflects a separate entity associated with increased risk or merely reflects accelerated presentation of DM. Methods and results: We analysed data on 15 089 hypertensive patients attending the Glasgow Blood Pressure Clinic. The date at first hospital encounter either with diagnosis of diabetes or prescription of anti-hyperglycaemic medication were considered as the onset of diabetes. Cox proportional hazard models (including propensity score matching) were employed to study associations between diabetes status, early and late NOD (diagnosis <10 years or >10 years from first clinic visit) and cause-specific mortality. There were 2516 patients (16.7%) with DM, of whom 1862 (12.3%) had NOD [early NOD = 705 (4.6%); late NOD = 1157 (7.6%)]. The incidence rate of NOD was 8.2 per 1000 person-years. The total time at risk was 239 929 person-years [median survival: 28.1 years (inter-quartile range: 16.2–39.9)]. Compared with non-diabetic individuals, prevalent DM [hazard ratio (HR) = 1.8, 95% confidence interval (CI): 1.4–2.2] and time varying NOD status (HR: 1.09, 95% CI: 1.06–1.17) were associated with increased adjusted all-cause mortality. Early NOD (HR: 1.39, 95% CI: 1.2–1.6) was associated with increased in mortality risk, but not late NOD (HR: 0.92, 95% CI: 0.83–1.01). Results were consistent in the propensity score matched analyses. Conclusion: Although 1-in-8 hypertensive patients develop NOD, mortality is increased only in the 1-in-20 who develop early NOD. Further studies are warranted to determine if early identification of such individuals should provide an alert for intensification of therapeutic interventions.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Lip, Miss Stefanie and Mccallum, Dr Linsay and McInnes, Professor Gordon and Padmanabhan, Professor Sandosh and Dominiczak, Professor Anna
Authors: Lip, S., Jeemon, P., Mccallum, L., Dominiczak, A. F., McInnes, G. T., and Padmanabhan, S.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:European Heart Journal
Publisher:Oxford University Press
ISSN:0195-668X
ISSN (Online):1522-9645

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