Abstract
BackgroundQuestions remain as to the association between essential hypertension and increased incidence of type 2 diabetes (T2DM). The premise of this analysis is that insulin resistance/compensatory hyperinsulinemia is a major predictor of T2DM, and the greater the prevalence of insulin resistance within any population, normotensive or hypertensive, the more likely T2DM will develop. The hypothesis to be tested is that surrogate estimates of insulin resistance will predict incident T2DM to a significant degree in persons with normal blood pressure or prehypertension.MethodsAnalysis of data from a population-based survey of 10, 038 inhabitants of rural and urban areas of Korea, ≥40 years-old, initiated in 2001, with measures of demographic and metabolic characteristics at baseline and 8-years later. Participants were classified as having normal blood pressure or prehypertension, and three simple manifestations of insulin resistance related to the pathophysiology of T2DM used to predict incident T2DM: (1) glycemia (plasma glucose concentration 2-hour after 75 g oral glucose challenge = 2-hour PG); (2) hyperinsulinemia (plasma insulin concentration 2-hour after 75 g oral glucose challenge = 2-hour PI); and (3) dyslipidemia (ratio of fasting plasma triglyceride/high/density lipoprotein cholesterol concentration = TG/HDL-C ratio).ResultsFully adjusted hazard ratios (HR, 95 % CI) for incident T2DM were highest (P < 0.001) in the quartile of individuals with the highest 2-hour PG concentrations, ranging from 5.84 (3.37–10.1) in women with prehypertension to 12.2 (7.12–21.00) in men with normal blood pressure. T2DM also developed to a significantly greater degree in subjects within the highest quartile of TG/HDL-C ratios, with HRs varying from 2.91 (1.63–2.58) in women with prehypertension (P < 0.001) to 1.77 (1.12–2.81, P < 0.05) in men with prehypertension. The least predictive index of insulin resistance was the 2-hour PI concentration. Subjects with normal blood pressure in the highest quartile of 2-hour PI concentrations were significantly associated with incident T2DM, with HRs of 1.5 (1.02–2.20, P = 0.25) and 2.02 (1.35–3.02, P < 0.001), in men and women, respectively. Finally, incidence of T2DM in the highest quartile was somewhat greater in patients with prehypertension, irrespective of predictor.ConclusionsMetabolic variables associated with insulin resistance (glycemia, insulinemia, and dyslipidemia) predict the development of T2DM in patients with either normal blood pressure or prehypertension.Electronic supplementary materialThe online version of this article (doi:10.1186/s12933-016-0368-7) contains supplementary material, which is available to authorized users.
Highlights
Questions remain as to the association between essential hypertension and increased incidence of type 2 diabetes (T2DM)
The association between elevated blood pressure and T2DM is not limited to inhabitants of the U.K., and results of the recent Korean Genome and Epidemiological Study have demonstrated that this relationship exists in patients with prehypertension [2]
The more specific hypothesis underlying this analysis is that surrogate estimates of insulin resistance will predict incident T2DM in a normal population, and in patients with prehypertension
Summary
Questions remain as to the association between essential hypertension and increased incidence of type 2 diabetes (T2DM). In an effort to obtain a more definitive view of the putative association between elevated blood pressure and T2DM, they analyzed medical records of 4.1 million individuals, free of hypertension and T2DM, in a U.K. primary care setting, as well as performing a meta-analysis of existing prospective studies. The results of their analysis documented a significant association between elevations of blood pressure and T2DM, and concluded that “further investigation is needed to determine whether this association is causal.”. The more specific hypothesis underlying this analysis is that surrogate estimates of insulin resistance will predict incident T2DM in a normal population, and in patients with prehypertension
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