Are blood pressure and diabetes additive or synergistic risk factors? outcome in 8494 subjects randomly recruited from 10 populations
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Are blood pressure and diabetes additive or synergistic risk factors? outcome in 8494 subjects randomly recruited from 10 populations. / Sehestedt, Thomas; Hansen, Tine W; Li, Yan; 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 Solskov; Torp-Pedersen, Christian; Jeppesen, Jørgen; Ibsen, Hans; Imai, Yutaka; Wang, Jiguang; Sandoya, Edgardo; Kawecka-Jaszcz, Kalina; Staessen, Jan A; Jeppesen, Jørgen Lykke.
I: Hypertension Research, Bind 34, 10.02.2011, s. 714-721.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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T1 - Are blood pressure and diabetes additive or synergistic risk factors? outcome in 8494 subjects randomly recruited from 10 populations
AU - Sehestedt, Thomas
AU - Hansen, Tine W
AU - Li, Yan
AU - Richart, Tom
AU - Boggia, Jose
AU - Kikuya, Masahiro
AU - Thijs, Lutgarde
AU - Stolarz-Skrzypek, Katarzyna
AU - Casiglia, Edoardo
AU - Tikhonoff, Valérie
AU - Malyutina, Sofia
AU - Nikitin, Yuri
AU - Björklund-Bodegård, Kristina
AU - Kuznetsova, Tatiana
AU - Ohkubo, Takayoshi
AU - Lind, Lars Solskov
AU - Torp-Pedersen, Christian
AU - Jeppesen, Jørgen
AU - Ibsen, Hans
AU - Imai, Yutaka
AU - Wang, Jiguang
AU - Sandoya, Edgardo
AU - Kawecka-Jaszcz, Kalina
AU - Staessen, Jan A
AU - Jeppesen, Jørgen Lykke
PY - 2011/2/10
Y1 - 2011/2/10
N2 - 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.
AB - 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.
U2 - 10.1038/hr.2011.6
DO - 10.1038/hr.2011.6
M3 - Journal article
C2 - 21307869
VL - 34
SP - 714
EP - 721
JO - Hypertension Research
JF - Hypertension Research
SN - 0916-9636
ER -
ID: 34116353