title: Blood pressure and the risk of developing diabetes in african americans and whites: ARIC, CARDIA, and the framingham heart study.
abstract: OBJECTIVE
  We examined the association between high blood pressure and incident type 2 diabetes in African Americans and whites aged 35-54 years at baseline.
  
  
  METHODS
  We combined data from the Atherosclerosis Risk in Communities (ARIC) study, the Coronary Artery Risk Development in Young Adults (CARDIA) study, and the Framingham Heart Study offspring cohort. Overall, 10,893 participants (57% women; 23% African American) were categorized by baseline blood pressure (normal, prehypertension, hypertension) and examined for incident diabetes (median follow-up 8.9 years).
  
  
  RESULTS
  Overall, 14.6% of African Americans and 7.9% of whites developed diabetes. Age-adjusted incidence was increasingly higher across increasing blood pressure groups (P values for trend: <0.05 for African American men; <0.001 for other race-sex groups). After adjustment for age, sex, BMI, fasting glucose, HDL cholesterol, and triglycerides, prehypertension or hypertension (compared with normal blood pressure) was associated with greater risks of diabetes in whites (hazard ratio [HR] for prehypertension: 1.32 [95% CI 1.09-1.61]; for hypertension: 1.25 [1.03-1.53]), but not African Americans (HR for prehypertension: 0.86 [0.63-1.17]; for hypertension: 0.92 [0.70-1.21]). HRs for developing diabetes among normotensive, prehypertensive, and hypertensive African Americans versus normotensive whites were: 2.75, 2.28, and 2.36, respectively (P values <0.001).
  
  
  CONCLUSIONS
  In African Americans, higher diabetes incidence among hypertensive individuals may be explained by BMI, fasting glucose, triglyceride, and HDL cholesterol. In whites, prehypertension and hypertension are associated with greater risk of diabetes, beyond that explained by other risk factors. African Americans, regardless of blood pressure, have greater risks of developing diabetes than whites.
authors.affiliation: Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA. weig@nhlbi.nih.gov
authors.forename: Gina S
authors.initials: GS
authors.lastname: Wei
authors.forename: Sean A
authors.initials: SA
authors.lastname: Coady
authors.forename: David C
authors.initials: DC
authors.lastname: Goff
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Brancati
authors.forename: Daniel
authors.initials: D
authors.lastname: Levy
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Selvin
authors.forename: Ramachandran S
authors.initials: RS
authors.lastname: Vasan
authors.forename: Caroline S
authors.initials: CS
authors.lastname: Fox
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D001794:Blood Pressure / Q000502:physiology*; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D044465:White People; D055815:Young Adult