• Online Features  This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (18)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Nutritional and Metabolic Disorders  • Nutritional and Metabolic Disorders, Other  • Drug Therapy  • Drug Therapy, Other  • Endocrine Diseases  • Diabetes Mellitus  • Hypertension  • Alert me on articles by topic  Social Bookmarking   What's this?

Ian H. de Boer, MD, MS; Bryan Kestenbaum, MD, MS; Tessa C. Rue, MS; Michael W. Steffes, MD, PhD; Patricia A. Cleary, MS; Mark E. Molitch, MD; John M. Lachin, ScD; Noel S. Weiss, MD, DrPH; John D. Brunzell, MD; for the Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) Study Research Group

Arch Intern Med. 2008;168(17):1867-1873.

Background  Diabetes mellitus and hypertension are closely linked, but the long-term blood pressure effects of glucose-lowering therapy and hyperglycemia are not clear.

Methods  We examined the effects of intensive insulin therapy and hyperglycemia on the development of hypertension in the Diabetes Control and Complications Trial (DCCT) and its observational follow-up, the Epidemiology of Diabetes Intervention and Complications (EDIC) study. Incident hypertension was defined as 2 consecutive study visits with a systolic blood pressure of 140 mm Hg or higher, a diastolic blood pressure of 90 mm Hg or higher, or use of antihypertensive medications to treat high blood pressure.

Results  Participants were enrolled from August 23, 1983, through June 30, 1989. During a 15.8-year median follow-up, 630 of 1441 participants developed hypertension. During the DCCT, the incidence of hypertension was similar comparing participants assigned to intensive vs conventional therapy. However, intensive therapy during the DCCT reduced the risk of incident hypertension by 24% during EDIC study follow-up (hazard ratio, 0.76; 95% confidence interval [CI], 0.64-0.92). A higher hemoglobin A_1c level, measured at baseline or throughout follow-up, was associated with increased risk for incident hypertension (adjusted hazard ratios, 1.11 [95% CI, 1.06-1.17] and 1.25 [95% CI, 1.14-1.37], respectively, for each 1% higher hemoglobin A_1c level), and glycemic control appeared to mediate the antihypertensive benefit of intensive therapy. Older age, male sex, family history of hypertension, greater baseline body mass index, weight gain, and greater albumin excretion rate were independently associated with increased risk of hypertension.

Conclusions  Hyperglycemia is a risk factor for incident hypertension in type 1 diabetes, and intensive insulin therapy reduces the long-term risk of developing hypertension.

Author Affiliations: Divisions of Nephrology (Drs de Boer and Kestenbaum) and Metabolism, Endocrinology, and Nutrition (Dr Brunzell), Department of Medicine, and Departments of Biostatistics (Ms Rue) and Epidemiology (Dr Weiss), University of Washington, Seattle; Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis (Dr Steffes); The Biostatistics Center (Ms Cleary and Dr Lachin), George Washington University, Washington, DC; and Division of Endocrinology, Department of Medicine, Northwestern University, Chicago, Illinois (Dr Molitch).
Group Information: A list of the DCCT/EDIC Study Research Group was published in JAMA. 2003;290(16):2166.

CiteULike    Connotea    Delicious    Digg    Facebook    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Limitations and Future Treatment Options in Type 2 Diabetes With Renal Impairment
Ritz
Diabetes Care 2011;34:S330-S334.
FULL TEXT  

Long-term Renal Outcomes of Patients With Type 1 Diabetes Mellitus and Microalbuminuria: An Analysis of the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Cohort
de Boer et al.
Arch Intern Med 2011;171:412-420.
ABSTRACT | FULL TEXT  

Progression of Carotid Artery Intima-Media Thickness During 12 Years in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study
Polak et al.
Diabetes 2011;60:607-613.
ABSTRACT | FULL TEXT  

Glucose, Insulin, and Incident Hypertension in the Multi-Ethnic Study of Atherosclerosis
Levin et al.
Am J Epidemiol 2010;172:1144-1154.
ABSTRACT | FULL TEXT  

The Role of Blood Pressure Variability in the Development of Nephropathy in Type 1 Diabetes
Kilpatrick et al.
Diabetes Care 2010;33:2442-2447.
ABSTRACT | FULL TEXT  

Early exposure of the pregestational intrauterine and postnatal growth-restricted female offspring to a peroxisome proliferator-activated receptor-{gamma} agonist
Garg et al.
Am. J. Physiol. Endocrinol. Metab. 2010;298:E489-E498.
ABSTRACT | FULL TEXT  

How Little Aldosterone is Able to Raise Blood Pressure?
Ritz
CJASN 2009;4:703-710.
FULL TEXT