Hypertension Is Associated with Increased Risk of Diabetic Lung

Q: What are the key findings of this study?

Coexisting hypertension and diabetes mellitus increased the odds of restrictive lung disease (FVCp < 80%) compared to normal blood pressure and normal glucose (OR 3.30, 95% CI 2.09-5.22, p < 0.001).

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Diabetes mellitus, prediabetes, and hypertension (n=4644). Intervention: Coexisting hypertension and diabetes mellitus vs. Normal blood pressure and normal fasting plasma glucose. Primary outcome: Restrictive lung disease (reduced forced vital capacity, FVCp < 80%) (OR 3.30, 95% CI 2.09-5.22, p=<0.001).

Q: What does this research mean for the field?

Coexisting hypertension and diabetes mellitus are synergistically associated with an increased risk of restrictive lung function impairment compared to normal blood pressure and glucose levels. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To investigate whether hypertension acts as an aggravating factor for impaired lung function and restrictive lung disease in patients with diabetes.

Ji‐Hyun Lee; Donghwan Kwon; Youngjang Lee; Inchan Jung; Dae-Sung Hyun; Hunju Lee; Yeon‐Soon Ahn

doi:10.3390/ijerph17207513

October 15, 2020International Journal of Environmental Research and Public HealthOpen Access

Hypertension Is Associated with Increased Risk of Diabetic Lung

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Key result

Coexisting hypertension and diabetes linked to ~3.3-fold higher odds of restrictive lung disease.

OR 3.30
95% CI 2.09-5.22
P<0.001
n=4,644

Figures

Why the study?

Lung function is often impaired in diabetic patients, and since hypertension is common in diabetes, this study investigated whether hypertension acts as an aggravating factor in diabetic lung.

Does coexisting hypertension and diabetes mellitus increase the risk of restrictive lung function impairment (FVCp < 80%) compared to normal blood pressure and normal glucose in adults aged 40-79 years?

Key Points

To investigate whether hypertension acts as an aggravating factor for impaired lung function and restrictive lung disease in patients with diabetes.
Analyzed cross-sectional data from 4644 subjects aged between 40 and 79 years from the 6th Korean National Health and Nutrition Examination Survey (KNHANES).
Assessed fasting plasma glucose, blood pressure, laboratory parameters, and spirometry, adjusting for age, sex, BMI, waist circumference, smoking, alcohol use, physical activity, and handgrip strength.
Lung function was significantly reduced in the hypertension (p = 0.001), impaired fasting glucose (p < 0.001), and diabetes mellitus (p < 0.001) groups.
The adjusted odds ratio of reduced forced vital capacity (FVCp < 80%) was 3.30 (95% CI: 2.09–5.22, p < 0.001) in the hypertension-diabetes group and 2.30 (95% CI: 1.66–3.18, p < 0.001) in the normal blood pressure-diabetes group.
The combination of hypertension and diabetes exhibited a synergistic negative effect on lung capacity beyond additive risk, yielding a relative excess risk due to interaction of 0.55.

Study Design

Type

Cross-Sectional (n=4,644)

Multicenter

Yes

Structured PICO

Does coexisting hypertension and diabetes mellitus increase the risk of restrictive lung function impairment (FVCp < 80%) compared to normal blood pressure and normal glucose in adults aged 40-79 years?

P

Population

4,644 civilian, noninstitutionalized Korean adults aged 40-79 years (54.3% female) from the nationwide KNHANES 2014-2015 cross-sectional survey with complete spirometry, blood pressure, and glycemic measurements.

E

Exposure

Coexisting hypertension (SBP ≥140 mmHg or DBP ≥90 mmHg) and diabetes mellitus (FPG ≥126 mg/dL or HbA1c ≥6.5%), as well as isolated diabetes, impaired fasting glucose (FPG 100-125 mg/dL or HbA1c 5.7-6.4%), or hypertension.

C

Comparator

Normal blood pressure (SBP <120 mmHg and DBP <80 mmHg) and normal fasting plasma glucose (<100 mg/dL and HbA1c <5.7%).

O

Outcome

Restrictive lung disease defined as reduced percentage of predicted forced vital capacity (FVCp < 80%) measured via dry rolling seal spirometry.surrogate

Main Result

Odds Ratio: 3.3 (95% CI 2.09–5.22)

p-value: p=<0.001

This nationwide cross-sectional study demonstrates that hypertension and diabetes have a synergistic association with restrictive lung function impairment (FVCp < 80%), suggesting that pulmonary function assessment is warranted in diabetic patients with poorly controlled blood pressure.

Limitations

Pulmonary function was only performed in subjects aged 40 years or older, preventing evaluation in younger generations.
Inflammatory reactants such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were not considered.
Cross-sectional design limited the ability to determine the causal effect and temporal sequence between exposures and outcomes.
Pulmonary function was only performed in subjects aged 40 years or older, so it was impossible to evaluate the effect of hypertension in young generations.
Inflammatory reactants such as the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were not considered.
The cross-sectional design limited the ability to determine the causal effect and temporal sequence between exposures and outcomes.

Implication

Coexisting hypertension and diabetes was associated with restrictive lung disease; hypothesis-generating and leaves open whether screening improves outcomes.

Abstract

Lung function is often impaired in diabetic patients, especially in a restrictive pattern, which has recently been described as the diabetic lung. Since hypertension (HTN) is common in diabetic patients, our study investigated whether HTN acts as an aggravating factor in diabetic lung. Within the cross-sectional study from the 6th Korean National Health and Nutrition Examination Survey (KNHANES), fasting plasma glucose (FPG), blood pressure (BP), pulmonary function, and laboratory data were examined in 4644 subjects aged between 40 and 79 years. A multivariate regression model was used to investigate the relationship between BP, FPG, and pulmonary function. Lung function was significantly reduced in the HTN (p = 0.001), impaired fasting glucose (IFG) (p < 0.001), and diabetes mellitus (DM) (p < 0.001) groups. Next, a multivariate logistic regression model was used to derive the odds ratio (OR) of reduced lung function based on the presence of IFG, DM, and HTN. The OR of reduced forced vital capacity (FVCp < 80%) was 3.30 (p < 0.001) in the HTN-DM group and 2.30 (p < 0.001) in the normal BP-DM group, when compared with the normal BP-normal FPG group. The combination of HTN and DM had the strongest negative effect on FVC. The results presented in this study indicate that diabetes and hypertension have a synergistic association with impaired lung function.

Discussion

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Cite This Study

Lee et al. (2020) conducted a cross-sectional in Diabetes mellitus, prediabetes, and hypertension (n=4,644). Coexisting hypertension and diabetes mellitus vs. Normal blood pressure and normal fasting plasma glucose was evaluated on Restrictive lung disease (reduced forced vital capacity, FVCp < 80%) (OR 3.30, 95% CI 2.09-5.22, p=<0.001). Coexisting hypertension and diabetes mellitus increased the odds of restrictive lung disease (FVCp < 80%) compared to normal blood pressure and normal glucose (OR 3.30, 95% CI 2.09-5.22, p < 0.001).

synapsesocial.com/papers/6a74736c96d04a2f43f53e70 https://doi.org/10.3390/ijerph17207513

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Hypertension Is Associated with Increased Risk of Diabetic Lung

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Hypertension Is Associated with Increased Risk of Diabetic Lung

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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