What is the clinical evidence from this study?

Study design: Cohort. Population: Diabetes (n=436). Intervention: Inadequate glycemic control (HbA1c ≥ 7%) vs. Adequate glycemic control (HbA1c < 7%). Primary outcome: Incident hypertension (HR 1.54, 95% CI 1.07-2.21, p=<0.05).

October 10, 2023Open Access

Association of glycemic control with hypertension in patients with diabetes: a population-based longitudinal study

Q: What are the key findings of this study?

Inadequate glycemic control (HbA1c ≥ 7%) was associated with a 54% higher risk of incident hypertension (HR 1.54) compared to adequate control among adults with diabetes.

Key Result

Inadequate glycemic control (HbA1c ≥ 7%) was associated with a 54% higher risk of incident hypertension (HR 1.54) compared to adequate control among adults with diabetes.

Study Design

Type

Cohort (n=436)

Multicenter

Yes

Structured PICO

Does insufficient glycemic control increase the risk of incident hypertension in adults with diabetes?

Population

436 middle-aged and older Chinese adults with diabetes, aged 45 years and older, followed for 7 years to assess the incidence of hypertension.

Exposure

Insufficient glycemic control (HbA1c ≥ 7%)

Comparator

Adequate glycemic control (HbA1c < 7%)

Outcome

Incident hypertension (ascertained through self-reported physician diagnoses) from 2011 to 2018hard clinical

Insufficient glycemic control (HbA1c ≥ 7%) is associated with a significantly higher risk of developing incident hypertension among middle-aged and older adults with diabetes.

Main Result

Hazard Ratio: 1.54 (95% CI 1.07–2.21)

Absolute Event Rate: 55.18% vs 40.6%

p-value: p=<0.05

Limitations

Lack of information on unmeasured confounders such as family history, diet, physical exercise, vascular damage, and renal dysfunction
Potential selection bias due to missing data
Use of self-reported questionnaires to identify hypertension
Inability to distinguish between type 1 and type 2 diabetes due to data limitations

Abstract

Abstract Background Diabetes increases the risk of hypertension morbidity, but whether this association is varied with glycemic control remains unknown. We aimed to examine the association of glycemic control with hypertension among individuals with diabetes. Methods Data was from the China Health and Retirement Longitudinal Study (CHARLS) between 2011 and 2018. Participants were categorized as having adequate glycemic control (HbA1c < 7%) and inadequate glycemic uncontrol (HbA1c ≥ 7%) by combining blood glucose tests and physician’s diagnoses in 2011. Incident hypertension was ascertained through self-reported physician diagnoses from 2011 to 2018. Cox proportional hazards regression models were used to examine the effect of glycemic control on hypertension. Results Among 436 participants with diabetes in this study, 102 met the glycemic control standard, and 334 were insufficient glycemic control. During 7 years of follow-up, 141 individuals developed hypertension. Compared with adequate glycemic control, the hazard ratio of inadequate glycemic control on hypertension was 1.54 (95% CI, 1.07–2.21) in the multivariate model. Additionally, the influence of glycemic control on hypertension varied based on educational attainment and the presence of depressive symptoms (P for interaction < 0.05). Conclusions Insufficient glycemic control was associated with a higher risk of hypertension among individuals with diabetes. Notably, the effect of glycemic control on hypertension was more pronounced among those with lower educational attainment and those exhibiting depressive symptoms. These findings underscore the significance of vigilant glycemic monitoring, educational background considerations, and mental health assessments in managing diabetic individuals.

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