Study: Arterial Stiffness May Be Superior to Hypertension in Predicting Diabetes

Results of a prospective cohort study, published in Hypertension, revealed that in addition to being associated with hypertension, diabetes is also linked with arterial stiffness (AS); among participants, AS was superior to hypertension in predicting diabetes.

In 2019, the global prevalence of diabetes among adults was 9.3%, and due to the aging population and unhealthy lifestyles, this total is projected to increase to 10.9% in 2045, authors wrote.

Previous research has explored the interplay between hypertension and diabetes, as the 2 conditions have numerous aspects in common like obesity and insulin resistance. According to authors, “hypertension may be considered as the greatest provoking factors for incident diabetes.”

However, AS has also been linked with the risk of insulin resistance and diabetes. To determine whether AS is superior to blood pressure (BP) in predicting diabetes onset, researchers conducted a cohort study among a community-based population in China.

A total of 11,156 individuals were included in the current analysis. Brachia-ankle pulse wave velocity (baPWV) was used to measure AS and “hypertension was defined as systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg, any use of the antihypertensive drug, or a self-reported history of hypertension,” researchers said. Fasting blood glucose levels were used to ascertain incident diabetes.

Individuals were divided into 4 groups based on hypertension and AS status: those with ideal vascular function (defined as normotension with normal AS), normotension with elevated AS, hypertension with normal AS, and hypertension with elevated AS.

Patients were followed for a median of 6.16 years and during this time, 768 developed diabetes.

Analyses revealed:

• Compared with the ideal vascular function group, the highest risk of diabetes was observed in those with hypertension snf elevated AS (hazard ratio [HR] 2.42; 95% CI, 1.93–3.03), followed by patients with normotension and elevated AS (HR 2.11; 95% CI, 1.68–2.66), while patients with hypertension and normal AS exhibited the lowest risk of diabetes (HR 1.48; 95% CI, 1.08–2.02)
• The addition of AS to a conventional models including traditional risk factors had a higher incremental effect on the predictive value for diabetes than the addition of hypertension (C statistics: 0.707 vs 0.695; integrated discrimination improvement: 0.65% vs 0.28%; net reclassification improvement: 40.48% vs 34.59%)

Currently, no consensus exists regarding the associations of AS and hypertension with diabetes, with previous studies yielding mixed results. However, past research has indicated AS is superior to BP when it comes to predicting cognitive decline and cardiovascular events, although AS was measured by different means in each study.

Potential preventive strategies have been proposed to lower AS, including antihypertensive medications and lifestyle modifications like smoking cessation and weight loss, but the exact underlying mechanism linking AS to diabetes risk remains unknown.

Lack of data on oral glucose tolerance tests and glycated hemoglobin mark a limitation to the study, while both hypertension and AS classifications were determined based on single measurements.

Overall, “participants with increased AS and hypertension exerted the highest risk of diabetes, which holds true in isolated systolic, isolated diastolic, high systolic and diastolic, controlled and uncontrolled hypertensives,” authors wrote.

“These findings indicated that preventive strategies on hypertension and AS may also contribute to the prevention of diabetes,” they concluded.

Reference

Tian X, Zuo Y, Chen S, et al. Hypertension, arterial stiffness, and diabetes: a prospective cohort study. Hypertension. Published online May 16, 2022. doi:10.1161/HYPERTENSIONAHA.122.19256