Association of uncontrolled hypertension or diabetes mellitus with major adverse cardiovascular events and mortality: a Korean population-based cohort study (Preprint)

BACKGROUND Although individuals with hypertension (HT) or diabetes mellitus (DM) strive to change their lifestyle and take medications, target blood pressure and blood glucose levels may not be reached. Few studies have investigated the incidence and risk of cardiovascular disease or mortality in the uncontrolled HT or DM conditions. OBJECTIVE We aimed to examine the association of HT or DM with incident cardiovascular disease or death. METHODS The Korean National Health Insurance Service-Health Screening Cohort aged 40–79 years (n = 440,249) that participated in national screening during 2002–2003 was used and was followed up to 2015. According to the HT or DM control status, incidence rates and hazard ratio (HR) for major adverse cardiovascular events (MACE) and death were estimated. Extended Cox regression was employed using time-dependent variables such as blood pressure (BP), fasting blood glucose (FBG), medication prescription, and adherence. RESULTS More than 60% of patients with HT or DM taking medication did not achieve the target BP or FBG. The incidence of MACE was 10.8–15.5 and 9.6–13.3 per 1,000 person-years with increasing age in the uncontrolled DM and uncontrolled HT groups, respectively. In the uncontrolled HT & DM group, however, the incidence of MACE was high (15.2–17.5 per 1000 person-years) at a relatively early age and showed no age-related trend. The increased risk of MACE was 28% in the uncontrolled DM group (adjusted HR, 1.28; 95% confidence interval [CI], 1.23–1.32), 32% in the uncontrolled HT group (1.32; 1.29–1.35), and 54% in the uncontrolled HT & DM group (1.54; 1.47–1.60). CONCLUSIONS Uncontrolled HT and uncontrolled DM were independent risk factors of MACE and all-cause death. An efficient system to continuously monitor BP and blood glucose is needed, particularly at an early age and in the uncontrolled group for both BP and FBG.