Hypertension Is Associated with a Higher Progression Rate of Insulin Resistance and the Incidence of Diabetes

Abstract

Background: Hypertension is a risk factor of diabetes. However, the underlying mechanisms are not fully elucidated. Therefore, we investigated this issue in a prospective cohort in Taiwan. Methods: A total of 1177 subjects without diabetes at baseline were enrolled from 20to 2016 at National Taiwan University Hospital Yun-Lin branch with a median follow-up period of 4.5 years. Diabetes was diagnosed by the results of OGTT and HbA1c, or if antidiabetic agents were used. Insulin resistance index by the Homeostatic model assessment 2 (HOMA2-IR) were used to estimate insulin resistance. Results: Subjects with hypertension by the JNC7 criteria had higher HOMA-IR at baseline and was associated with increased incidence of diabetes, adjusted for HOMA2-%B, HOMA2-IR, BMI, HbA1c, plasma triglyceride, age, gender, family history of diabetes and plasma CRP (adjusted HR 1.51, 95% CI 1.04-2.20, p=0.030). Subjects with treated hypertension had the highest risk of diabetes, followed by subjects with newly-diagnosed hypertension, compared with subjects with pre-hypertension and normal subjects. The progression rate of HOMA2-IR every 5 years (δHOMA2-IR/5 year) was higher in subjects with hypertension than in subjects without hypertension (adjusted p=0.001). Subjects with treated hypertension had the highest δHOMA2-IR/5 year, followed by subjects with newly-diagnosed hypertension, compared with normal subjects (adjusted p for trend=0.05). However, hypertension by the 2017 ACC/AHA criteria was not significantly associated with incident diabetes in adjusted models. The δHOMA2-IR/5 year for hypertension by this criteria was lower than that by the JNC7 criteria. Conclusion: Hypertension is associated with an accelerated progression of insulin resistance and an increased risk of diabetes. Application of 2017 ACC/AHA criteria for hypertension attenuates the associations. Disclosure C. Lin: None. H. Li: None.