title: Glycated hemoglobin and risk of hypertension in the atherosclerosis risk in communities study.
abstract: OBJECTIVE
  Diabetes and hypertension often co-occur and share risk factors. Hypertension is known to predict diabetes. However, hyperglycemia also may be independently associated with future development of hypertension. We investigated glycated hemoglobin (HbA(1c)) as a predictor of incident hypertension.
  
  
  METHODS
  We conducted a prospective analysis of 9,603 middle-aged participants in the Atherosclerosis Risk in Communities Study without hypertension at baseline. Using Cox proportional hazards models, we estimated the association between HbA(1c) at baseline and incident hypertension by two definitions 1) self-reported hypertension during a maximum of 18 years of follow-up and 2) measured blood pressure or hypertension medication use at clinic visits for a maximum of 9 years of follow-up.
  
  
  RESULTS
  We observed 4,800 self-reported and 1,670 visit-based hypertension cases among those without diagnosed diabetes at baseline. Among those with diagnosed diabetes at baseline, we observed 377 self-reported and 119 visit-based hypertension cases. Higher baseline HbA(1c) was associated with an increased risk of hypertension in subjects with and without diabetes. Compared with nondiabetic adults with HbA(1c) <5.7%, HbA(1c) in the prediabetic range (5.7-6.4%) was independently associated with incident self-reported hypertension (hazard ratio 1.14 [95% CI 1.06-1.23]) and visit-detected hypertension (1.17 [1.03-1.33]).
  
  
  CONCLUSIONS
  We observed that individuals with elevated HbA(1c), even without a prior diabetes diagnosis, are at increased risk of hypertension. HbA(1c) is a known predictor of incident heart disease and stroke. Our results suggest that the association of HbA(1c) with cardiovascular risk may be partially mediated by the development of hypertension.
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. jbower@jhsph.edu
authors.forename: Julie K
authors.initials: JK
authors.lastname: Bower
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Appel
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Matsushita
authors.forename: J Hunter
authors.initials: JH
authors.lastname: Young
authors.forename: Alvaro
authors.initials: A
authors.lastname: Alonso
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Brancati
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Selvin
mesh_terms: D050197:Atherosclerosis / Q000453:epidemiology / Q000378:metabolism*; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000378:metabolism; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000378:metabolism
chemical_list: D006442:Glycated Hemoglobin