The incidence of hypertension in insulin-dependent diabetes

TLDR: Control of hyperglycemia and prevention of gross proteinuria may lead to a reduction in the long-term incidence of hypertension in people with diabetes.

Abstract: Background: There are few epidemiologic data describing the long-term incidence of hypertension in people with diabetes. Methods: In a population-based study performed in southern Wisconsin, 765 individuals diagnosed as having diabetes when they were younger than 30 years and taking insulin participated in baseline, 4-year, and 10-year examinations. Blood pressure was measured by standardized protocols, and hypertension was defined as a mean systolic blood pressure of 160 mm Hg or more (≥140 mm Hg in those younger than 25 years) and/or mean diastolic blood pressure of 95 mm Hg or more (≥90 mm Hg in those younger than 25 years) and/or history of hypertension with the use of antihypertensive medication. Results: The prevalence of hypertension at baseline was 17.3%. The 10-year incidence of hypertension was 25.9%. The incidence of hypertension was greater with older age, longer duration of diabetes, higher glycosylated hemoglobin level, proteinuria, more severe retinopathy, and male gender. After other risk factors were controlled for, the 10-year incidence of hypertension was significantly related to higher glycosylated hemoglobin level (odds ratio, 1.23 per percentage increase; 95% confidence interval, 1.13 to 1.34), presence of gross proteinuria (odds ratio, 3.64; 95% confidence interval, 2.26 to 5.85), longer duration of diabetes (odds ratio, 1.03 per year of diabetes; 95% confidence interval, 1.01 to 1.04), and being male (odds ratio, 1.93; 95% confidence interval, 1.34 to 2.77). Conclusion: These data suggest that control of hyperglycemia and prevention of gross proteinuria may lead to a reduction in the long-term incidence of hypertension. (Arch Intern Med. 1996;156:622-627)