by Lewis Chang, PhD
Data from a recent epidemiological study revealed the bidirectional, pathogenic relationship between type 2 diabetes (T2D) and hypertension (HTN).1
Both T2D and HTN are important risk factors of cardiovascular disease. Previous epidemiological studies have shown that the presence of HTN predicts future T2D. An international team of researchers from Italy, Mexico and the US were interested in whether the presence of T2D predicted future HTN.
Two cohorts were included in this study. The first was the cohort of the Mexico City Diabetes Study consisting of approximately 2000 Hispanic whites from low-income areas, and the second was from the Framingham Offspring Study which included roughly 4000 non-Hispanic whites. Over the course of 7 years, the investigators analyzed the pattern of blood pressure (BP) changes during the development of HTN in individuals with or without T2D.
Their data analysis revealed several important clinical findings:
- The prevalence of T2D was significantly higher in individuals with HTN than those with normal BP
- In individuals with normal BP at baseline, having T2D at baseline was a significant predictor of developing HTN during follow-up
- In individuals with normal blood glucose at baseline, having HTN at baseline was a significant predictor of developing T2D during follow-up
- The progression from normal BP to HTN was marked by a steep increase in BP values (~20 mmHg) within 3.5 years
- Insulin resistance has an important, biologically plausible, role for the development of both T2D and HTN
These findings were true for both the low-income Hispanic whites and the more affluent non-Hispanic whites. In addition, among individuals who were healthy at baseline but later developed HTN or T2D during follow-ups, they shared a metabolic syndrome phenotype.
Why is this Clinically Relevant?
- The development of HTN in individuals with T2D will complicate treatment strategy and drastically increase healthcare costs
- Clinicians should closely monitor patients with T2D whose BP values are near the upper limit of normal range (review updated ACC/AHA HTN guidelines here)
- This is especially important if these individuals have the metabolic syndrome phenotype or a family history of HTN
- Lifestyle modification is essential for the prevention and treatment of T2D and HTN
1. Tsimihodimos V, Gonzalez-Villalpando C, Meigs JB, Ferrannini E. Hypertension and diabetes mellitus: coprediction and time trajectories. Hypertension. 2018;71(3):422-428.