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Title: Are blood pressure and diabetes additive or synergistic risk factors? outcome in 8494 subjects randomly recruited from 10 populations
Authors: Sehestedt, Thomas ×
Hansen, Tine W
Richart, Tom
Boggia, Jose
Kikuya, Masahiro
Thijs, Lutgarde
Stolarz-Skrzypek, Katarzyna
Casiglia, Edoardo
Tikhonoff, Valérie
Malyutina, Sofia
Nikitin, Yuri
Björklund-Bodegård, Kristina
Kuznetsova, Tatiana
Ohkubo, Takayoshi
Lind, Lars
Torp-Pedersen, Christian
Jeppesen, Jørgen
Ibsen, Hans
Imai, Yutaka
Wang, Jiguang
Sandoya, Edgardo
Kawecka-Jaszcz, Kalina
Staessen, Jan A #
Issue Date: Jun-2011
Publisher: The Society
Series Title: Hypertension research : official journal of the Japanese Society of Hypertension vol:34 issue:6 pages:714-721
Abstract: It remains unknown whether diabetes and high blood pressure (BP) are simply additive risk factors for cardiovascular outcome or whether they act synergistically and potentiate one another. We performed 24-h ambulatory BP monitoring in 8494 subjects (mean age, 54.6 years; 47.0% women; 6.9% diabetic patients) enrolled in prospective population studies in 10 countries. In multivariable-adjusted Cox regression, we assessed the additive as opposed to the synergistic effects of BP and diabetes in relation to a composite cardiovascular endpoint by testing the significance of appropriate interaction terms. During 10.6 years (median follow-up), 1066 participants had a cardiovascular complication. Diabetes mellitus as well as the 24-h ambulatory BP were independent and powerful predictors of the composite cardiovascular endpoint. However, there was no synergistic interaction between diabetes and 24-h, daytime, or nighttime, systolic or diastolic ambulatory BP (P for interaction, 0.07P0.97). The only exception was a borderline synergistic effect between diabetes and daytime diastolic BP in relation to the composite cardiovascular endpoint (P=0.04). In diabetic patients, with normotension as the reference group, the adjusted hazard ratios for the cardiovascular endpoint were 1.35 (95% confidence interval (CI), 0.87-2.11) for white-coat hypertension, 1.78 (95% CI, 1.22-2.60) for masked hypertension and 2.44 (95% CI, 1.92-3.11) for sustained hypertension. The hazard ratios for non-diabetic subjects were not different from those of diabetic patients (P-values for interaction, 0.09P0.72). In conclusion, in a large international population-based database, both diabetes mellitus and BP contributed equally to the risk of cardiovascular complications without evidence for a synergistic effect.Hypertension Research advance online publication, 10 February 2011; doi:10.1038/hr.2011.6.
ISSN: 0916-9636
Publication status: published
KU Leuven publication type: IT
Appears in Collections:Hypertension and Cardiovascular Epidemiology
× corresponding author
# (joint) last author

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