Status of hypertension and coronary stenosis in asymptomatic type 2 diabetic patients: analysis from Coronary Computed Tomographic Angiography Registry.
BACKGROUND
Limited data exist regarding the prevalence of coronary artery disease (CAD) as well as clinical outcomes in asymptomatic diabetic patients with normotension, controlled hypertension, and uncontrolled hypertension.


METHODS
We enrolled 935 consecutive asymptomatic type 2 diabetic patients without known CAD. Coronary computed tomography angiography was used to evaluate the prevalence and severity of CAD. Blood pressure was measured at baseline. Patients were assigned to one of the three groups: normotension (n=314), controlled hypertension (systolic blood pressure (SBP)< 140 mm Hg with treatment, n=458), or uncontrolled hypertension (SBP ≥ 140 mm Hg with or without treatment, n=163).


RESULTS
Obstructive CAD (≥ 50% stenosis) increased from the prevalence in normotensive patients (33%) to that in patients with controlled (40%) or uncontrolled hypertension (52%) (p=0.003). The incidence of obstructive CAD in multivessel or left main CAD also increased across the three groups (13%, 21%, 32%, respectively, p<0.001). A multivariate logistic regression analysis showed that uncontrolled hypertension was an independent predictor of obstructive CAD (adjusted odds ratio, 2.13; 95% confidence interval (CI), 1.42 to 3.21, p<0.001). During a median follow-up of 3.1 years, uncontrolled hypertension was associated with increased risk of cardiac death or myocardial infarction compared to the risk in normotensive patients (hazard ratio, 6.11; 95% CI, 1.65 to 22.6, p=0.007).


CONCLUSIONS
In asymptomatic type 2 diabetic patients, uncontrolled hypertension was associated with increased risk of CAD and poor clinical outcomes.
Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
Eun-Ho
EH
Choo
Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
Jin-Jin
JJ
Kim
Cardiovascular Center and Cardiology Division, St. Paul's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
Byung-Hee
BH
Hwang
Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
Ik Jun
IJ
Choi
Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
Mineok
M
Chang
Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
Sungmin
S
Lim
Cardiovascular Center and Cardiology Division, Uijeongbu St Mary's Hospital, The Catholic University of Korea, Uijeongbu, Republic of Korea.
Yoon-Seok
YS
Koh
Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
Hun Jun
HJ
Park
Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
Pum-Joon
PJ
Kim
Division of Endocrinology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
Seung-Hwan
SH
Lee
Division of Endocrinology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
Keon-Ho
KH
Yoon
Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
Jung-Im
JI
Jung
Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
Wook Sung
WS
Chung
Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
Ki-Bae
KB
Seung
Division of Endocrinology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea. Electronic address: drhopper@catholic.ac.kr.
Jae-Hyung
JH
Cho
Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea. Electronic address: kiyuk@catholic.ac.kr.
Kiyuk
K
Chang
D000368:Aged; D058070:Asymptomatic Diseases; D017023:Coronary Angiography / Q000379:methods*; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003925:Diabetic Angiopathies / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D015995:Prevalence; D012042:Registries; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed
Asymptomatic ischemia; Blood pressure control; Computed tomography; Coronary artery disease; Diabetes; Hypertension