Abstract
BackgroundAbnormal glucose metabolism has been suggested to be involved in the development of hypertension. This study investigated the effect of the association and potential interaction of glycosylated hemoglobin (HbA1c) and other factors on the risk of hypertension among Chinese nondiabetic adults.MethodsAs a cross-sectional survey, the current work deployed a questionnaire survey, anthropometric tests, and biochemical measures for each of the eligible participants. The HbA1c levels were quantified and grouped by quartiles. Correlations between HbA1c and hypertension, isolated systolic hypertension (ISH), and isolated diastolic hypertension (IDH) risk were investigated by logistic analyses. For evaluating the interactive effects, the parameters of relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index (SI) were calculated, respectively.ResultsIn the current study, 1462 nondiabetic subjects were enrolled. In total, the prevalence rates of hypertension, ISH and IDH were 22.4, 9.6 and 4.5%, respectively. When HbA1c levels were grouped by quartile, it was revealed that the prevalence rates of hypertension and ISH were substantially elevated across groups (Pfor trend < 0.001). In the multivariable logistic regression analyses, in comparison with the first quartile of HbA1c, the normalized OR for hypertension risk was 1.90 (95% CI: 1.28–2.80) for the highest quartile. Also, the risk of ISH was significantly increased with HbA1c level in the highest quartile relative to in the bottom quartile (OR: 2.23,95% CI:1.47–3.71). However, no significant relationship between the HbA1c level and IDH risk was observed (OR: 1.78, 95% CI: 0.82–3.84). Eventually, it was demonstrated from the interactive effect analysis that HbA1c significantly interacted with abdominal obesity (RERI: 1.48, 95% CI: 0.38–2.58; AP: 0.37, 95% CI: 0.14–0.60 and SI: 1.96, 95% CI: 1.06–3.62) and family history of hypertension (AP: 0.37, 95% CI: 0.05–0.70) in influencing the risk of hypertension in nondiabetic participants.ConclusionHigher HbA1c levels significantly enhanced the risk of hypertension and ISH, but not IDH among Chinese nondiabetic adults. Moreover, the risk of hypertension was also aggravated by the upregulated HbA1c in a synergistic manner alongside abdominal obesity and family history of hypertension.
Highlights
Abnormal glucose metabolism has been suggested to be involved in the development of hypertension
A national survey of 451,755 participants from 31 provinces in China estimated that nearly 244.5 million people were suffering from hypertension [2]
It was believed that 54% of stroke cases and 47% of ischemic disease cases were attributable to hypertension worldwide [7]
Summary
As a cross-sectional survey, the current work deployed a questionnaire survey, anthropometric tests, and biochemical measures for each of the eligible participants. For evaluating the interactive effects, the parameters of relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index (SI) were calculated, respectively. Three indicators reflecting interactive effects, including (1) the relative excess risk due to interaction (RERI), (2) attributable proportion due to interaction (AP), and (3) the synergy index (SI), were calculated. They were defined as follows: RERI = OR11 − OR10 − OR01 + 1, AP = RERI/ OR11, and SI = (OR11–1) / (OR01–1) + (OR10–1) [23, 24]. Two-sided p-values were calculated and p < 0.05 was considered to be statistically significant
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