Is intensive BP treatment associated with increased diabetes risk? finds AHA study

USA: Intensive BP (blood pressure) treatment versus standard strategy was not associated with increased diabetes mellitus but was associated with more impaired fasting glucose (IFG), according to a recent study in the AHA journal Hypertension.

Diabetes and high BP make a deadly combination as one condition makes the other worse. Diabetes may increase BP by reducing the ability of blood vessels to stretch, increasing the fluid in the body and affecting insulin management.

Intensive lowering of blood pressure is a technique that keeps BP levels at or below 130/80 mmHg. The 2017 AHA blood pressure guidelines have recommended intensive treatment for people with diabetes and hypertension to help reduce their blood pressure.

Christianne L. Roumie, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, and colleagues evaluated diabetes mellitus incidence in this SPRINT (Systolic Blood Pressure Intervention Trial) that compared intensive blood pressure strategy (systolic blood pressure <120 mm Hg) versus standard strategy (<140 mm Hg).

The study involved 9361 randomized participants and 981 excluded; 4187 participants were assigned to intensive strategy and 4193 to standard strategy. Participants were ≥50 years of age, with systolic 130 to 180 mm Hg and increased cardiovascular risk. Participants having diabetes mellitus, polycystic kidney disease, proteinuria >1 g/d, heart failure, dementia, or stroke, were excluded. Post randomization exclusions included participants missing blood glucose or ≥126 mg/dL (6.99 mmol/L) or on hypoglycemics.

The outcome was incident diabetes mellitus: fasting blood glucose ≥126 mg/dL (6.99 mmol/L), diabetes mellitus self-report, or new use of hypoglycemics. The secondary outcome was impaired fasting glucose (100–125 mg/dL [5.55–6.94 mmol/L]) among those with normoglycemia (<100 mg/dL [5.55 mmol/L]).

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Key findings of the study include:

• Diabetes events (reaching fasting blood glucose ≥126 mg/dL [≥6.99 mmol/L], self-report of diabetes at annual examination, new use of hypoglycemic medications): Intensive: 299, Standard: 251.


• After adjustments for baseline covariates, adjusted (a)HR was 1.17.


• Elevated fasting glucose event rates -- intensive: 12.7 per 1000 person-years, standard: 10.4 per 1000 person-years; aHR, 1.19.


• New diabetes self-report rates were 11.9 per 1000 person-years in intensive versus 8.8 per 1000 person-years in standard; aHR, 1.33.


• IFG incidence rates with normal baseline blood glucose were 26.4 per 100 person-years in intensive and 22.5 per 100 person-years in standard; aHR, 1.17.

"Intensive treatment strategy was not associated with increased diabetes mellitus but was associated with more impaired fasting glucose. The risks and benefits of intensive blood pressure targets should be factored into individualized patient treatment goals," concluded the authors.

The study, "Blood Pressure Control and the Association With Diabetes Mellitus Incidence: Results From SPRINT Randomized Trial," is published in the AHA journal Hypertension.

DOI: https://doi.org/10.1161/HYPERTENSIONAHA.118.12572