title: Hypertensive target organ damage predicts incident diabetes mellitus.
abstract: OBJECTIVE
  Whether patients with hypertensive preclinical cardiovascular disease (CVD) are at higher risk of incident diabetes has never been studied.
  
  
  RESULTS
  We assessed incident diabetes in 4176 hypertensive non-diabetic patients (age 58.7 ± 8.9 years, 58% male) with ≥1 year follow-up (median: 3.57 years; inter-quartile range: 2.04-7.25). Left ventricular (LV) hypertrophy (LVH) was defined as LV mass index (LVMi) ≥51 g/m(2.7). Carotid atherosclerosis (CA) was defined as intima-media thickness >1.5 mm. During follow-up, diabetes developed in 393 patients (9.4%), more frequently in those with than without initial LVH or CA (odds ratio = 1.97 and 1.67, respectively; both P < 0.0001). In the Cox regression, the presence of either initial LVH or CA was associated with higher hazard of diabetes [hazards ratio (HR) = 1.30 and 1.38, respectively; both P = 0.03], independently of the type and number of anti-hypertensive medications, initial systolic blood pressure (P < 0.001), body mass index, fasting glucose, family history of diabetes (all P < 0.0001), and therapy with β-blockers. The presence of one of the, or both, markers of preclinical CVD increased the chance of incident diabetes by 63 or 64%, respectively (both P < 0.002), independently of significant confounders, a result that was confirmed (HR = 1.70 or 1.93, respectively; both P < 0.0001) using ATPIII metabolic syndrome (HR = 2.73; P < 0.0001) in the Cox model.
  
  
  CONCLUSIONS
  Initial LVH and CA are significant predictors of new onset diabetes in a large population of treated hypertensive patients, independently of initial metabolic profile, anti-hypertensive therapy, and other significant covariates. This sequence may be attributable to risk factors common to preclinical CVD and diabetes, but a vascular origin of diabetes cannot be excluded.
authors.affiliation: Department of Translational Medical Sciences, Federico II University Hospital, via S. Pansini 5, 80131 Naples, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Izzo
authors.forename: Giovanni
authors.initials: G
authors.lastname: de Simone
authors.forename: Valentina
authors.initials: V
authors.lastname: Trimarco
authors.forename: Eva
authors.initials: E
authors.lastname: Gerdts
authors.forename: Renata
authors.initials: R
authors.lastname: Giudice
authors.forename: Olga
authors.initials: O
authors.lastname: Vaccaro
authors.forename: Nicola
authors.initials: N
authors.lastname: De Luca
authors.forename: Bruno
authors.initials: B
authors.lastname: Trimarco
mesh_terms: D015992:Body Mass Index; D002340:Carotid Artery Diseases / Q000150:complications; D059168:Carotid Intima-Media Thickness; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000209:etiology*; D003925:Diabetic Angiopathies / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications*; D017379:Hypertrophy, Left Ventricular / Q000150:complications; D033162:Incidental Findings; D008297:Male; D024821:Metabolic Syndrome / Q000209:etiology; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D012044:Regression Analysis; D012307:Risk Factors
keywords: Diabetes; Hypertension; Metabolic syndrome; Target organ damage