title: Longitudinal Study of Hypertensive Subjects With Type 2 Diabetes Mellitus: Overall and Cardiovascular Risk.
abstract: Despite adequate glycemic and blood pressure control, treated type 2 diabetic hypertensive subjects have a significantly elevated overall/cardiovascular risk. We studied 244 816 normotensive and 99 720 hypertensive subjects (including 7480 type 2 diabetics) attending medical checkups between 1992 and 2011. We sought to identify significant differences in overall/cardiovascular risk between hypertension with and without diabetes mellitus. Mean follow-up was 12.7 years; 14 050 all-cause deaths were reported. From normotensive to hypertensive populations, a significant progression in overall/cardiovascular mortality was observed. Mortality was significantly greater among diabetic than nondiabetic hypertensive subjects (all-cause mortality, 14.05% versus 7.43%; and cardiovascular mortality, 1.28% versus 0.7%). No interaction was observed between hemodynamic measurements and overall/cardiovascular risk, suggesting that blood pressure factors, even during drug therapy, could not explain the differences in mortality rates between diabetic and nondiabetic hypertensive patients. Using cross-sectional regression models, a significant association was observed between higher education levels, lower levels of anxiety and depression, and reduced overall mortality in diabetic hypertensive subjects, while impaired renal function, a history of stroke and myocardial infarction, and increased alcohol and tobacco consumption were significantly associated with increased mortality. Blood pressure and glycemic control alone cannot reverse overall/cardiovascular risk in diabetics with hypertension. Together with cardiovascular measures, overall prevention should include recommendations to reduce alcohol and tobacco consumption and improve stress, education levels, and physical activity.
authors.affiliation: From the AP-HP, Diagnostic and Therapeutic Center, Paris Descartes University, Hôtel-Dieu, France (M.E.S., J.-B.G., S.A.B., A.Y.); Centre d'investigations préventives et cliniques (IPC), Paris, France (F.T.); and Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon (S.A.B.). michel.safar@htd.aphp.fr.
authors.forename: Michel E
authors.initials: ME
authors.lastname: Safar
authors.affiliation: From the AP-HP, Diagnostic and Therapeutic Center, Paris Descartes University, Hôtel-Dieu, France (M.E.S., J.-B.G., S.A.B., A.Y.); Centre d'investigations préventives et cliniques (IPC), Paris, France (F.T.); and Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon (S.A.B.).
authors.forename: Jean-Barthélémy
authors.initials: JB
authors.lastname: Gnakaméné
authors.affiliation: From the AP-HP, Diagnostic and Therapeutic Center, Paris Descartes University, Hôtel-Dieu, France (M.E.S., J.-B.G., S.A.B., A.Y.); Centre d'investigations préventives et cliniques (IPC), Paris, France (F.T.); and Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon (S.A.B.).
authors.forename: Sola Aoun
authors.initials: SA
authors.lastname: Bahous
authors.affiliation: From the AP-HP, Diagnostic and Therapeutic Center, Paris Descartes University, Hôtel-Dieu, France (M.E.S., J.-B.G., S.A.B., A.Y.); Centre d'investigations préventives et cliniques (IPC), Paris, France (F.T.); and Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon (S.A.B.).
authors.forename: Alexandra
authors.initials: A
authors.lastname: Yannoutsos
authors.affiliation: From the AP-HP, Diagnostic and Therapeutic Center, Paris Descartes University, Hôtel-Dieu, France (M.E.S., J.-B.G., S.A.B., A.Y.); Centre d'investigations préventives et cliniques (IPC), Paris, France (F.T.); and Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon (S.A.B.).
authors.forename: Frédérique
authors.initials: F
authors.lastname: Thomas
mesh_terms: D000328:Adult; D017677:Age Distribution; D001786:Blood Glucose / Q000032:analysis; D001795:Blood Pressure Determination; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D002423:Cause of Death; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D006334:Heart Function Tests; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D016019:Survival Analysis
chemical_list: D001786:Blood Glucose
keywords: aortic stiffness; cardiovascular risk; hypertension; overall risk; type 2 diabetes mellitus