ISOLATED SYSTOLIC HYPERTENSION AS THE PREDOMINANT HYPERTENSION SUBTYPE IN DIABETES

Abstract

Therapeutic Area: Diabetes Background: Hypertension (HTN) and diabetes mellitus (DM) are both leading contributors to the development of cardiovascular disease (CVD). Furthermore, HTN subtypes may impact CVD outcomes to varying degrees. Data are limited on the association of HTN subtypes comparing those with versus without DM. The aim of this project is to examine the association of DM status with HTN subtypes. Methods: A total of 19,062 adults (projected to 39 million adults) from the National Health and Nutrition Examination Survey years 1999-2016 with untreated HTN, defined as a systolic blood pressure (BP) ≥ 130 or diastolic BP ≥ 80 mm Hg, were included in the analysis. Individuals were further stratified by HTN subtype: isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systolic-diastolic hypertension (SDH). Multiple logistic regression analyses examined the relation of diabetes and glycemic control to the likelihood of ISH. Results: Among the subjects examined, 16.4% had DM and among those a greater proportion (65%) had ISH compared to 36% in those without DM (p<0.001). Conversely, those without DM had relatively higher prevalence of IDH and SDH: 23% and 31%, respectively, compared to 9% and 26%, respectively, in those with DM. On average, those with DM and HTN had significantly higher BP (146/73 mm Hg) compared to those with HTN but without DM (140/78 mm Hg). Presence of diabetes was independently associated with the likelihood of having ISH (p<0.001, OR 1.550, 95% CI 1.391-1.728) when controlled for sex, age, dyslipidemia, smoking status, and ethnicity. However, neither the severity of diabetes based on HbA1c nor clinically significant duration of DM (≥10 years) was associated with increased prevalence of ISH (p=0.305 and p=0.262, respectively). Conclusions: Patients with DM are significantly more likely to have ISH, an indicator of arterial stiffness, as well as higher levels of systolic BP compared to those without DM who have HTN. This may help explain the increased CVD risks observed in those with DM and warrants greater consideration for systolic BP control particularly in those with DM. Further investigation should examine how CVD outcomes are impacted by different HTN subtypes in those with DM.