Increased CV, death risk in diabetics largely due to coexistent hypertension
MedWire News: Results from a subanalysis of the Framingham Heart Study (FHS) suggest that the increased risk for death and cardiovascular (CV) events known to occur in patients with diabetes is primarily due to concomitant hypertension.
"Increased attention to the role of blood pressure (BP) control in preventing CV events in individuals with diabetes mellitus is essential, particularly in light of evidence that hypertension is the most poorly controlled of the cardiac risk factors in patients with diabetes," say the authors.
Finlay McAlister, from the University of Alberta Hospital in Edmonton, Canada, and team assessed the 4-year risk for CV events among a subgroup of 1145 individuals from the FHS.
All participants had newly diagnosed diabetes and no history of CV events, and 58% had concomitant hypertension, defined as a BP of at least 130/80 mmHg or current use of antihypertensive medication.
As reported in the journal Hypertension, McAlister and team found that 125 patients died during the 4-year follow-up, and 204 had a CV event, defined as stroke, myocardial infarction, or heart failure.
The researchers noted a higher rate of death and CV events among the patients with diabetes and hypertension compared with those with diabetes alone, at a rate of 32 versus 20 deaths per 1000 person-years, and 52 versus 31 CV events per 1000 person-years, respectively.
This translated to a 72% higher risk for death from any cause, and a 57% higher risk for any CV event among hypertensive compared with nonhypertensive diabetics, after adjustment for demographic and clinical variables, say McAlister et al.
When a similar analysis was performed in a group of 5596 nondiabetic FHS participants, the researchers found that hypertension was associated with an 81% and 98% increase in risk for all-cause mortality and CV events, respectively.
In an accompanying commentary, Christian Torp-Pedersen and Jørgen Jeppesen (University of Copenhagen) concluded: "Although diabetes remains a risk factor for atherosclerotic CV disease, the main focus of intervention needs to be directed to hypertension and cholesterol control in terms of reducing this risk.
"Treatment should most likely be completely independent of the presence of diabetes mellitus."
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By Lauretta Ihonor