Association of mean arterial pressure with 5-year risk of incident diabetes in Chinese adults：a secondary population-based cohort study

Abstract

Objective Hypertension predicts the development of diabetes. However, there are still lacking high-quality studies on the correlation between mean arterial pressure (MAP) and incident diabetes. We aimed to explore the relationship between MAP and diabetes in Chinese adults.Design This is a secondary retrospective cohort study and the data were downloaded from the ‘DATADRYAD’ database (www.Datadryad.org).Participants The study included 210 418 adults without diabetes at baseline between 2010 and 2016 across 32 sites and 11 cities in China.Setting The target-independent and dependent variables were MAP measured at baseline and diabetes occurred during follow-up. Cox proportional hazards regression was used to explore the relationship between MAP and diabetes.Primary outcome measures The outcome was incident diabetes, which was defined as fasting blood glucose ≥7.00 mmol/L and/or self-reported diabetes during follow-up. Patients were censored either at the time of the diagnosis or at the last visit, whichever comes first.Results 3927 participants developed diabetes during a 5-year follow-up. After adjusting covariates, MAP positively correlated with diabetes (HR=1.008, 95% CI 1.005 to 1.011, p<0.001), and the absolute risk difference was 0.02%. E-value analysis and multiple imputations were used to explore the robustness of the results. The relationship between MAP and diabetes was also non-linear, and the inflection point of MAP was 100.333 mm Hg. Subgroup analysis revealed a stronger association between MAP and diabetes in people with age (≥30,<50 years old), fasting plasma glucose <6.1 mmol/L and drinking. Additionally, receiver operating characteristic (ROC) curves showed the predictive performance of MAP for diabetes was similar to systolic blood pressure (SBP) (area under the curve (AUC)=0.694 with MAP vs AUC=0.698 with SBP).Conclusions MAP is an independent predictor for a 5-year risk of incident diabetes among Chinese adults. The relationship between MAP and diabetes is also non-linear. When MAP is below 100.333 mm Hg, MAP is closely positively related to diabetes.