Reliable quantification of the association between blood pressure and risk of type 2 diabetes mellitus is lacking.
A study sought to determine the association between usual blood pressure and risk of diabetes, overall and by participant characteristics.
A cohort of 4.1 million adults, free of diabetes mellitus and cardiovascular disease, was identified using validated linked electronic health records. Analyses were complemented by a meta-analysis of prospective studies that reported relative risks of new-onset diabetes per unit of systolic blood pressure.
Among the overall cohort, 20 mm Hg higher systolic blood pressure and 10 mm Hg higher diastolic blood pressure were associated with a 58% and a 52% higher risk of new-onset diabetes ( hazard ratio, HR=1.58; 95% confidence interval [CI]: 1.56 to 1.59; and HR=1.52; 95% confidence interval: 1.51 to 1.54 ), respectively.
There was no evidence of a nadir to a baseline blood pressure of 110/70 mm Hg.
The strength of the association per 20 mm Hg higher systolic blood pressure declined with age and with increasing body mass index.
Estimates were similar even after excluding individuals prescribed antihypertensive or lipid-lowering therapies.
Systematic review identified 30 studies with 285,664 participants and 17,388 incident diabetes events.
The pooled relative risk of diabetes for a 20 mm Hg higher usual systolic blood pressure across these studies was 1.77 ( 1.53 to 2.05 ).
In conclusion, people with elevated blood pressure are at increased risk of diabetes. The strength of the association declined with increasing body mass index and age.
Further research should determine if the observed risk is modifiable. ( Xagena )
Emdin CA et al, J Am Coll Cardiol 2015;66:1552-1562