Different cutoffs of hypertension, risk of incident diabetes and progression of insulin resistance: A prospective cohort study

Chia-Hung Lin; Jung-Nan Wei; Kang-Chih Fan; Chi-Tai Fang; Wan-Chen Wu; Chung-Yi Yang; Mao-Shin Lin; Shyang-Rong Shih; Cyue-Huei Hua; Yenh-Chen Hsein; Jou-Wei Lin; Lee-Ming Chuang; Hung-Yuan Li

doi:10.1016/j.jfma.2021.02.022

Different cutoffs of hypertension, risk of incident diabetes and progression of insulin resistance: A prospective cohort study

J Formos Med Assoc. 2022 Jan;121(1 Pt 1):193-201. doi: 10.1016/j.jfma.2021.02.022. Epub 2021 Mar 22.

Authors

Chia-Hung Lin¹, Jung-Nan Wei², Kang-Chih Fan¹, Chi-Tai Fang³, Wan-Chen Wu⁴, Chung-Yi Yang⁵, Mao-Shin Lin⁶, Shyang-Rong Shih⁷, Cyue-Huei Hua⁸, Yenh-Chen Hsein⁸, Jou-Wei Lin⁹, Lee-Ming Chuang¹⁰, Hung-Yuan Li¹¹

Affiliations

¹ Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan.
² Chia-Nan University of Pharmacy and Science, Tainan, Taiwan.
³ Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
⁴ Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
⁵ Department of Medical Imaging, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
⁶ Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
⁷ Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Center of Anti-Aging and Health Consultation, National Taiwan University Hospital, Taipei, Taiwan.
⁸ Division of Clinical Pathology National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, Taiwan.
⁹ Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, Taiwan.
¹⁰ Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
¹¹ Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: larsli@ntuh.gov.tw.

PMID: 33766449
DOI: 10.1016/j.jfma.2021.02.022

Abstract

Background/purpose: Hypertension is a risk factor of incident diabetes. In 2017, the ACC/AHA updated the definition of hypertension to above 130/80 mmHg, while the 2018 ESC/ESH guideline and the JNC7 criteria remained the cutoff of 140/90 mmHg. This study was aimed to investigate how different cutoffs of hypertension affect the association of hypertension to incident diabetes and the progression of insulin resistance.

Methods: A total of 1177 subjects without diabetes at baseline were followed for 4.5 years. Diabetes was diagnosed by the results of oral glucose tolerance tests and hemoglobin A1c, or if anti-diabetic agents were used.

Results: Hypertension by both criteria was associated with incident diabetes. Change of HOMA2-IR every 5 years (ΔHOMA2-IR/5 yr) was higher in subjects with hypertension than those without (adjusted p = 0.044). Subjects with treated hypertension had the highest risk of diabetes (HR 2.98, p < 0.001) and ΔHOMA2-IR/5 yr, compared with subjects with normal blood pressure. However, the associations of hypertension, HR of incident diabetes and ΔHOMA2-IR/5 yr were attenuated by the 2017 ACC/AHA criteria, as compared with that by the JNC7 and 2018 ESC/ESH criteria.

Conclusion: Hypertension by both criteria is associated with incident diabetes and accelerated progression of insulin resistance, and the associations are attenuated by the 2017 ACC/AHA criteria.

Keywords: Cutoffs; Diabetes mellitus; Hypertension; Insulin resistance.

MeSH terms

Diabetes Mellitus* / epidemiology
Humans
Hypertension* / epidemiology
Insulin Resistance*
Prospective Studies