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The Journal of Cardiometabolic Syndrome (ISSN 1524-6175) is published quarterly by Le Jacq Ltd.

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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
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ORIGINAL ARTICLE

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id: 5513

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

O

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 reflects
a mere coincidence of two common
disorders afflicting predominantly the
middle-aged and older subjects, to the
recognition that hypertension is a major
modifier 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 confirmed that both the
relative and absolute benefits of hypotensive treatment in preventing coronary
events and stroke were larger in diabetics
than in the rest of the treated hypertensive population.2–4 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 definitions 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 definition 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 definition 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 afflict 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;1:95–101) ©2006 Le Jacq Ltd.
Emma Kabakov, MD;1 Clara Norymberg, MD;3 Esther Osher, MD;1
Michael Koffler, 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
definition 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 different cohorts. The first 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 HMO’s 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 different
area in Israel (the city of Givatayim).
JCMS spring 2006

95

“cohort 3”). 2) the criterion used for the definition of hypertension during the years 1993–2000. highdensity lipoprotein (HDL) cholesterol. CT 06820-3652. whereas all the background variants and the laboratory measurements taken at the beginning of follow-up constituted the explaining variables. JCMS spring 2006 .1711 x106. triglycerides. glycosylated hemoglobin. smoking habits. and presence of hypertension on the other hand.. was assessed by the chi-square test.e. i. and 3) the new cutoff levels applied for the detection of hypertension in diabetes as of the year 2000. i. all significant correlations were further introduced into a model of logistic regression. weight. recording. cohort 2 (n=677). or any information storage and retrieval system.4 mg/dL in men or >1. Prevalence of hypertension in diabetes as a function of age (n=2218). as defined by three different cut-off values Referral to this clinic was based on the primary care physician’s assessment. on three separate occasions. Three Parklands Drive..2 mg/dL in women. low-density lipoprotein (LDL) cholesterol. such that body mass index (BMI) could be calculated as well. please contact Sarah Howell at showell@lejacq.001) 0 21–30 (n= 20) 31–40 (n= 83) 41–50 (n= 339) 51–60 (n= 541) 61–70 (n= 758) 71–80 (n= 400) 81–90 (n= 77) Age (years) Figure 2. All rights reserved. absence of evidence suggestive of type 1 diabetes or diabetes secondary to endocrinopathy. and serum creatinine. i.. Patients were examined for BP. BP ≥130/80 mm Hg.The Journal of Cardiometabolic Syndrome (ISSN 1524-6175) is published quarterly by Le Jacq Ltd. Finally.e. BP ≥140/90 mm Hg. the dependent variable in the regression was the presence of hypertension. and all details concerning past and current medical treatment were 96 prevalence of hypertension in diabetes ® recorded. The relation between gender.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. with an average of two measurements recorded for each visit. comprised patients from the diabetes clinic of the Tel Aviv-Sourasky Medical Center. In this analysis. and baseline laboratory including at least fasting glucose and/or glycosylated hemoglobin. physical examination. Prevalence of hypertension in diabetes according to cohorts: cohort 1 (n=625). electronic or mechanical.001) 20 140 /90 (p<0. The following criteria were applied for inclusion in this study: satisfactory admission notes including medical history. including photocopy. the last cohort (n=625. without permission in writing from the publishers. unequivocal evidence of diabetes mellitus. a major referral center in the metropolitan Tel Aviv area. For copies in excess of 25 or for commercial purposes. and height. The opinions and ideas expressed in this publication are those of the authors and do not necessarily reflect those of the Editors or Publisher. Although retrospective in nature. Subjects were interviewed and medical history. The presence of hypertension was defined for the entire patient population according to three different criteria: 1) the classic criterion of hypertension used in the general population. Comparison among hypertension rates according to the different criteria was done by analysis of variance with repeated measurements. and no particular general criteria were applied in the referral process. this analysis is based on a similar practice of BP measurement confirmed by the participating authors. 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. Definitions. family history of diabetes.10 Statistical Methods. p<0. BP ≥130/85 mm Hg. Copyright ©2006 by Le Jacq Ltd. which includes the use of sphygmomanometry following 5 minutes in the sitting position.e.com or 203. Data were collected during the patient’s first visit to the clinic. Laboratory analysis included total serum cholesterol.. cohort 3 (n=925). No part of this publication may be reproduced or transmitted in any form or by any means.001) 130 /85 (p<0. and clear documentation of pretreatment BP as recorded in the patient’s chart by one of the authors participating in this survey.. and family history of diabetes on the one hand.656. Abnormal renal function (“chronic renal failure”) was defined as serum creatinine >1. serum glucose. Darien. To analyze the independent influence of each factor on hypertension. smoking.

.7%. and 91.0004 0.4% for ages 41–50 years. clinical.3/47.2 161.74 9. and 86. Demographic. respectively.8±5. 76. respectively (p<0.5±12. CT 06820-3652.6 214.6 78. and biochemical characteristics of the study groups are detailed in Table I.0004 100 90 Prevalence (%) Demographic. decreasing the upper limit of the normal range of BP resulted in a higher percentage of subjects classified as hypertensive. Darien. LDL=low-density lipoprotein.9 N/A N/A 173. respectively.5±22.7±38.98±0. The opinions and ideas expressed in this publication are those of the authors and do not necessarily reflect those of the Editors or Publisher. reaching 92% in comparison to 87% and 78.29 N/A P VALUE 0.656.1 78.0/44 Percent 60.4±10 137. the prevalence of hypertension was higher in subjects whose BMI exceeded 30 kg/m2.3 0.6% in JCMS spring 2006 97 .1±4.1 148.7±25.5%.0±48.5 56.3±14. Expectedly.6 Age (yr) 140.0±10 167. BP levels ≥130/80 mm Hg.35 1.0001 <0.1 HDL cholesterol (mg/dL) Triglycerides (mg/dL) 197. 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 3.0001 <0.2 211.6 60. the prevalence of hypertension as defined at the three different levels was higher in patients from cohort 3 (the referral center).15 <0.48 BP=blood pressure. As shown in Figure 2.5% and 85. Clinical. including photocopy.4% (Figure 2).7 142.7% among patients between the ages of 31 and 40 years.1 0. and Biochemical Characteristics of the Study Group TOTAL COHORT 1 COHORT 2 PARAMETER (MEAN ± SD) No.9 Weight (kg) 162.0001 0. the prevalence of hypertension in the entire 2227 diabetic patients was 60.05±0. applying the current criteria for hypertension in diabetes.28 215. The prevalence of high BP was generally somewhat higher in diabetic women than in diabetic men (Figure 3).e. recording.0001). All rights reserved.8 228.2 138.0±47.8% of the entire study population had BP levels equal to or higher than 130/85 and 130/80 mm Hg.5 Systolic BP (mm Hg) Diastolic BP (mm Hg) 81.4±12.6±13. the prevalence of hypertension clearly increased with age. i.8±22.7±14. First. Not surprisingly. However..3±45.33±2.1 Total cholesterol (mg/dL) 133.22 9.9 222. and 93.8 80.96±0. The prevalence of hypertension in the oldest group.3% in cohorts 2 and 1.7±10. without permission in writing from the publishers.0001 <0. please contact Sarah Howell at showell@lejacq.The Journal of Cardiometabolic Syndrome (ISSN 1524-6175) is published quarterly by Le Jacq Ltd.0% for people aged 71–80 years.3% of patients with BMI >30 kg/m2 (n=466) were hypertensive according to cutoff values at 140/90.5 227.006. Three Parklands Drive.2 61.1±17.1%.2±9.9 LDL cholesterol (mg/dL) 45. the derived rates of hypertension were 62.5±40.9±39. For copies in excess of 25 or for commercial purposes.8%. regardless of the particular criteria by which high BP was defined: 69.1±8. or any information storage and retrieval system.8±14. the gender-related difference in the rate of hypertension was no longer detectable.5 130.6±11. as opposed to a prevalence of 56. Prevalence of hypertension in diabetes according to gender.0 29. Hence.7 28.6 77.0±9. when current cutoff BP levels (≥130/80 mm Hg) were applied to define hypertension.7 55. 79.0001 <0. 1164 men.2 45.3 0.0001 0.5±54.4/52.6±11. Of note also is the relation between weight and the prevalence of high BP in this survey. According to classic criteria for hypertension defined as BP ≥140/90 mm Hg.5 29. 130/85 and 130/80 mm Hg.7±8 75.0001 0. 76. HDL=high-density lipoprotein Results prevalence of hypertension in diabetes ® 438/487 47.3±4.7 86.2243 <0.5/44. Figure 1 depicts the breakdown of the prevalence of hypertension in the three cohorts according to the new criteria.4±156.4 61.4% for ages 60–70 years.91±0.4±13. when the cutoff level for defining hypertension was set at 130/80 mm Hg (Figure 1).2 46.com or 203. of patients 2227 625 677 Male/female 1164/1063 347/278 379/298 Number 52.7 164. **p=0. 1063 women.3±14.7±187.3±5.2±14.6 79.002 85.96±3. No part of this publication may be reproduced or transmitted in any form or by any means.1711 x106.7 Height (cm) Body mass index (kg/m2) 29.7±110. Table I. Copyright ©2006 by Le Jacq Ltd..0987 <0.09±2.2%. For example. 84.38 Creatinine (mg/dL) Glycosylated hemoglobin (%) 9.2±16.2±155. comprising subjects aged 80 years or older. electronic or mechanical. *p=0. was 94.

Copyright ©2006 by Le Jacq Ltd.0001 for all comparisons).013) 130/85 (p=0. A) Prevalence of hypertension in diabetes according to body mass index (BMI) (n=1250). or any information storage and retrieval system.1–35.0 (n=90) 25. whereas the prevalence of hypertension was “only” 75. while the prevalence of hypertension (≥130/80 mm Hg) in type 2 diabetics with BMI <25 kg/m2 was ≈82%.0 (n=39) BMI (kg/m2 ) C 100 Prevalence (%) 80 60 Blood pressure (mm Hg) 40 130/80 (p=0.0 (n=135) >35. A 100 Prevalence (%) 80 60 Blood pressure (mm Hg) 40 130/80 (p<0.01) (Table II). including photocopy. n=74) as opposed to 85% among diabetic patients with preserved kidney function (n=1873.001) 0 ≤25 (n=237) 25–30 (n=547) 30–35 (n=335) >35 (n=131) BMI (kg/m2 ) B 100 Prevalence (%) 80 60 Blood pressure (mm Hg) 40 130/80 (p=0.002) 0 ≤25. women only (n=626). Finally.1–30.com or 203. A clear relation was found between the presence of increased serum creatinine and the prevalence of hypertension.The Journal of Cardiometabolic Syndrome (ISSN 1524-6175) is published quarterly by Le Jacq Ltd.1–30.001) 20 140/90 (p<0.0 (n=147) 25. Since serum creatinine is gender dependent.0 (n=92) BMI (kg/m2) Figure 4. Furthermore..4 mg/ dL. as the prevalence of high BP appears to rise with increasing obesity in men. Even if hypertension was defined according to the pre-1993 criterion (BP ≥140/90 mm Hg). For example.1–35.021) 130/85 (p=0. please contact Sarah Howell at showell@lejacq.011) 20 140/90 (p=0. recording. CT 06820-3652.001) 130/85 (p<0. in each case as defined by three different cutoff values 98 prevalence of hypertension in diabetes ® patients with BMI <30 kg/m2 (n=784) using the same definitions for hypertension (p<0.4% in the group having a normal creatinine level. This relationship may be somewhat genderspecific. C) Prevalence of hypertension in diabetes according to body mass index (BMI). the prevalence of hypertension was 73% among patients with clear renal impairment. we found a direct and highly significant correlation between the degree of obesity (according to BMI groups) and the prevalence of hypertension (Figure 4a).12) 0 ≤25. When hypertension was defined as ≥130/85 mm Hg. electronic or mechanical.0 (n=305) 30. Darien. No part of this publication may be reproduced or transmitted in any form or by any means. whereas women in the highest BMI group (>35 kg/m2) exhibit a somewhat lower rate of hypertension than women with BMI of 30–35 kg/m2 (Figures 4b and 4c).0 (n=242) 30. the relation between the severity of obesity and the prevalence of hypertension was maintained among diabetic women as well as men. without permission in writing from the publishers..055) 20 140/90 (p=0.1711 x106. compared with a rate of 58% in subjects presumed to have normal kidney function (p<0. p=0. the presence of hypertension was nearly universal among diabetic subjects with morbid obesity.006) (Table II). All rights reserved. For copies in excess of 25 or for commercial purposes. The opinions and ideas expressed in this publication are those of the authors and do not necessarily reflect those of the Editors or Publisher.5% of patients suffering from kidney failure were found to be hypertensive as well.656. There was no relation between the prevalence of hypertension according to the different diagnostic thresholds and the degree of glycemic control (not shown). the relation between renal disease and JCMS spring 2006 . 90.0 (n=200) >35. men only (n=624). the rate of hypertension (BP ≥130/80 mm Hg) was 96% among subjects with chronic renal failure (defined by serum creatinine ≥1. Three Parklands Drive. For example. B) Prevalence of hypertension in diabetes according to body mass index (BMI).

02 0.4 p value 0. as defined by any of the these cutoff levels was more common in the presence of hypertriglyceridemia (serum triglycerides ≥150 mg/dL). or any information storage and retrieval system. the probability of having hypertension increased by 3.7 74.012 0.8 72 54 <200 mg/dL p value 0. 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). p=0.4 mg/dL in men and ≥1.1%–3. the prevalence of hypertension defined as BP ≥130/80 mm Hg was 86% among subjects with LDL cholesterol ≥100 mg/dL compared with 73...7% in patients with normal HDL cholesterol levels (p=0.1 63. For copies in excess of 25 or for commercial purposes. we performed logistic regression analyses of factors related to the presence of hypertension as defined by the three different cutoff values (Table III). CT 06820-3652.4mg/dL 96 90.006 0.1 >150 mg/dL 84.018).4 mg/dL p value 0. i.16 0.5 78. then the rate of high BP is 93% among diabetic patients with impaired renal function (n=114). hypertension. hypertension can be further delineated by applying gender-related criteria to the definition of chronic renal failure. JCMS spring 2006 99 . but only age.002 LDL cholesterol 86. with the lowest prevalence of hypertension in this survey.2 >100 mg/dL <100 mg/dL 73.1711 x106. Darien.5 73 85 75. electronic or mechanical.003 0. All rights reserved. They likely reflect variations in the prevalence of hypertension in three different clinical settings.2 mg/dL in women. we set out to assess the impact of the tightening definition of hypertension on the prevalence of this disease in three cohorts of diabetic patients.4 58 <1. As shown. We also identified an association between presence of hypertension and serum lipid levels (Table II). Still. Because many of the parameters associated with increased BP in our study are clearly related to each other. All factors directly related to the presence of hypertension were considered for these analyses. depending on the specific cutoff level used for the definition of hypertension.656.3 57.2% per each BMI unit (kg/m2). female gender significantly increased the chance of the presence of hypertension. compared with 85% among those having preserved kidney function (n=1833.5% among diabetic patients with low HDL cholesterol (under 45 mg/dL) compared with 81.e.3 >200 mg/dL 82. likely reflects or is at least closely related to the rate of elevated BP in diabetic patients soon after the detection of diabetes mellitus. HDL=high-density lipoprotein per year with advancing age.8 <45 mg/dL >45 mg/dL 81.7% in subjects with lower serum LDL cholesterol concentrations (p<0. please contact Sarah Howell at showell@lejacq. as referral of patients composing this particular cohort was mandatory for all newly diagnosed diabetics.13 This assumption appears reasonable.2 74. the probability of increased BP increased by 3. Similar relationships also existed when the looser criteria for the definition of high BP were applied..035) (Table II). some diabetic patients may have been included in this cohort simply because they moved into the area or joined the specific HMO offering the clinic providing the data to our study. and BMI appeared consistently related to hypertension by all three sets of criteria. The intercohort differences in the prevalence of hypertension are fairly consistent across the various sets of threshold values used to define elevated BP in this study.5%–4.003 0.005 0. gender.4 <150 mg/dL p value 0. The opinions and ideas expressed in this publication are those of the authors and do not necessarily reflect those of the Editors or Publisher. the overall prevalence of hypertension has increased from ≈60% to 86% as the threshold for the definition of high BP has been lowered. The community-based cohort 1. Rather expectedly.035 0. An inverted association was found between HDL cholesterol level and the presence of hypertension when the latter was defined by the strictest criteria: the prevalence of BP ≥130/80 mm Hg was 86. including photocopy.61 LDL=low-density lipoprotein.5 78 61. Copyright ©2006 by Le Jacq Ltd. For example. Discussion In the present study. 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 >1.8 61.0001 0. without permission in writing from the publishers. No part of this publication may be reproduced or transmitted in any form or by any means.1 61. recording.035 Total cholesterol 87 78. 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.com or 203.11 In accordance with previous reports in the general population.4 63.17 HDL cholesterol 86.0001). Given the estimated prevalence of hypertension in the general population and the mean age of our study population (≈61 years).5 p value <0. As shown. Three Parklands Drive.8 56. If hypertension is defined by the cutoff levels of ≥130/80 mm Hg. All other confounding factors had no independent effect in this model.1 77. serum creatinine ≥1. and finally.The Journal of Cardiometabolic Syndrome (ISSN 1524-6175) is published quarterly by Le Jacq Ltd.01 Triglycerides 88.8% prevalence of hypertension in diabetes ® Table II.12 the prevalence of hypertension increased with age and reached almost 95% among diabetic patients over the age of 80.7 68.013 0.

All rights reserved.0007 index (1.730 0. more difficult to control in terms of glycemia.com or 203.656.950) (0. as it may provide clues to better vascular protection in diabetes.011–1. based on glycosylated hemoglobin levels. we show a clear correlation between BMI and the prevalence of hypertension in patients with diabetes. but is “only” 92% in women in the same BMI range. which potentially deserves further in-depth study. the observed rate of hypertensive subjects among diabetics with creatinine levels ≥1. but appears to level off and perhaps even decline in women at the highest BMI range. may be more representative of the general diabetic population. Summary of Logistic Regression Analysis of Factors Related to the Presence of Hypertension as Defined by Three Different Cutoff 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. electronic or mechanical.556–0. JCMS spring 2006 .0266 Gender (0.0001 1. Our analysis unravels a link among several indices of dyslipidemia and the prevalence of high BP. Interestingly.001 0. In this respect.. such that the segregation of a higher rate of increased BP with higher cholesterol levels is not entirely selfevident. obesity is a predictor of subsequent cardiovascular disease.0001 0. however.044) 0.250 0.045) (1. total cholesterol differs little between diabetic subjects and controls.022 0.22 Obesity is also a recognized factor in the pathogenesis of hypertension in general. the hospital-based cohort 3.5 1.2 1.1 (1.23 the prevalence of hypertension approaches 100% in obese diabetic men with BMI ≥35 kg/m2. however.002) 1.727 <0.16 We are not aware.4 mg/dL) is in accord with the presumed role of renal disease in diabetic hypertension.911–2.4 mg/dL drops from 96% to 73%.20 who noted that the prevalence of hypertension among diabetic patients with evidence of nephropathy exceeded 85%.The Journal of Cardiometabolic Syndrome (ISSN 1524-6175) is published quarterly by Le Jacq Ltd.051) (1. Table III. Finally. such that the prevalence rises continuously with BMI in men.032 <0. in addition to uncontrolled diabetes. This diabetic normotensive phenotype. on the average.739 <0. As hypertension appears to eventually afflict the vast majority of diabetic patients. without permission in writing from the publishers. Copyright ©2006 by Le Jacq Ltd.957) (0.3 1. In the present analysis. The opinions and ideas expressed in this publication are those of the authors and do not necessarily reflect those of the Editors or Publisher. may be important to characterize in greater detail.059) (1.019–1. as one important limitation of our analysis. In the general population.802–1.15.559 0. in that we were unable to determine with certainty the duration of diabetes in the patients included in this study. both clinically and genetically.004) (0.018–1.025–1. that an association among elevated arterial pressure and high total and LDL cholesterol 100 prevalence of hypertension in diabetes ® has been previously reported in diabetic subjects.001 0. or any information storage and retrieval system. Our survey suggests. Darien..14 In some cases. Notably. that a significant 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 define hypertension. We also note sexual dimorphism in this relationship.998–1.09 1.002) (1.668) (0.035 0.0001 1.18 Nephropathy is a dominant and well established cause for hypertension among diabetic patients. however. 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. showing the highest rate of hypertension.016–1.7 Total cholesterol (1.042 0.565–0. clearly represents patients who are. as it included a mixture of recently diagnosed patients and patients with longstanding disease requiring the help of a diabetes specialist.1711 x106.001 0.1 Creatinine (0.000–1. on the other hand.19 The finding in this study that hypertension is nearly universal (prevalence of 96%) in subjects with significantly impaired renal function (creatinine >1.003) Triglycerides 1. are known to cosegregate in the metabolic syndrome.17.0001 (1. Three Parklands Drive..002) (1.038 <0. but its effect on the presence of hypertension in diabetic subjects has not been directly addressed in previous studies.003 0.005) (0.558–0.998–1. cardiovascular risk factors tend to cluster with hypertension.558) CI=95% confidence interval The community-based cohort 2.001 0. uncontrolled hypertension may have comprised the real impetus for referral in this cohort. recording. our data are similar to recent analyses by Bakris et al.020–1. For copies in excess of 25 or for commercial purposes.039 0.965) Body mass 1.031 <0.000 0. Among diabetic patients.065) (1. including photocopy. the minority of diabetic patients not developing hypertension emerges as a unique group.9 1. CT 06820-3652. showing a somewhat higher prevalence of hypertension. apparently “immune” to the evolution of hypertension. 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.062) 1.000–1.507 0.0003 1.000–1.000–1.0003 1.21. No part of this publication may be reproduced or transmitted in any form or by any means. This assessment should be qualified.888–2. please contact Sarah Howell at showell@lejacq.1 1.950) (0. Hypertension and low HDL or/and high triglyceride concentrations.

JCMS spring 2006 101 . Darien. detection. CT 06820-3652. Pan WH. 1999. The treatment of hypertension in adult patients with diabetes. Am J Kidney Dis. Circulation. Cardiol Clin. Mensah GA. Copyright ©2006 by Le Jacq Ltd. J Hypertens. 1996. and treatment of high blood pressure [published correction appears in Arch Intern Med. Bennett PH. 2004.153:154–183. et al.276:1886–1892. Orth SR. Neil HA. 2004.1711 x106. et al. All rights reserved. other risk factors. and Treatment of High Blood Pressure (JNC V). 2003. Arch Intern Med. Control of cardiovascular risk factors in patients with diabetes and hypertension at urban academic medical centers. National Kidney Foundation Hypertension and Diabetes Executive Committees Working 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).286:1195–1200. JAMA. et al.289:2560–2572. 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