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)

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, Dr Stefanie and Mccallum, Dr Linsay and Padmanabhan, Professor Sandosh and Dominiczak, Professor Anna and McInnes, Professor Gordon
• 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 > School of Cardiovascular & Metabolic Health
• Journal Name: European Heart Journal
• Publisher: Oxford University Press
• ISSN: 0195-668X
• ISSN (Online): 1522-9645