Hypertension, Arterial Stiffness, and Diabetes: a Prospective Cohort Study
Xue Tian, Yingting Zuo, Shuohua Chen, Yijun Zhang, Xiaoli Zhang, Qin Xu, Shouling Wu, Anxin Wang
Abstract
BACKGROUND: Whether the combination of different blood pressure and arterial stiffness (AS) status is independently associated with diabetes has not been fully investigated so far. This study aimed at investigating the status of hypertension and AS in determining diabetes. METHODS: This prospective cohort study included 11 156 participants from the Kailuan study. AS was measured by brachial-ankle pulse wave velocity. We compared the risk of diabetes between individuals with ideal vascular function (defined as normotension with normal AS), normotension with elevated AS, hypertension with normal AS, and hypertension with elevated AS. RESULTS: After a median follow-up of 6.16 years, diabetes occurred in 768 participants. Compared with ideal vascular function group, the highest risk of diabetes was observed in hypertension with elevated AS group (hazard ratio, 2.42 [95% CI, 1.93-3.03]), followed by normotension with elevated AS group (hazard ratio, 2.11 [95% CI, 1.68-2.66]), hypertension with normal AS group exhibited the lowest risk of diabetes (hazard ratio, 1.48 [95% CI, 1.08-2.02]). Multiple sensitivity and subgroup analyses yielded similar results. Furthermore, the additional of AS to a conventional model including traditional risk factors had a higher incremental effect on the predictive value for diabetes than the addition of hypertension (the C statistics was 0.707 versus 0.695; the integrated discrimination improvement was 0.65% versus 0.28%; net reclassification improvement was 40.48% versus 34.59%). CONCLUSIONS: Diabetes is associated with not only hypertension but also AS. Additionally, AS shows a better predictive ability than hypertension in predicting diabetes.