Are blood pressure and diabetes additive or synergistic risk factors? outcome in 8494 subjects randomly recruited from 10 populations

Thomas Sehestedt; Tine W Hansen; Yan Li; Tom Richart; Jose Boggia; Masahiro Kikuya; Lutgarde Thijs; Katarzyna Stolarz-Skrzypek; Edoardo Casiglia; Valérie Tikhonoff; Sofia Malyutina; Yuri Nikitin; Kristina Björklund-Bodegård; Tatiana Kuznetsova; Takayoshi Ohkubo; Lars Solskov Lind; Christian Torp-Pedersen; Jørgen Jeppesen; Hans Ibsen; Yutaka Imai; Jiguang Wang; Edgardo Sandoya; Kalina Kawecka-Jaszcz; Jan A Staessen; Jørgen Lykke Jeppesen

doi:10.1038/hr.2011.6

Are blood pressure and diabetes additive or synergistic risk factors? outcome in 8494 subjects randomly recruited from 10 populations

Thomas Sehestedt, Tine W Hansen, Yan Li, Tom Richart, Jose Boggia, Masahiro Kikuya, Lutgarde Thijs, Katarzyna Stolarz-Skrzypek, Edoardo Casiglia, Valérie Tikhonoff, Sofia Malyutina, Yuri Nikitin, Kristina Björklund-Bodegård, Tatiana Kuznetsova, Takayoshi Ohkubo, Lars Solskov Lind, Christian Torp-Pedersen, Jørgen Jeppesen, Hans Ibsen, Yutaka ImaiJiguang Wang, Edgardo Sandoya, Kalina Kawecka-Jaszcz, Jan A Staessen, Jørgen Lykke Jeppesen

19 Citationer (Scopus)

Abstract

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, 0.07P0.97). The only exception was a borderline synergistic effect between diabetes and daytime diastolic BP in relation to the composite cardiovascular endpoint (P0.04). 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, 0.09P0.72). 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.

Originalsprog	Engelsk
Tidsskrift	Hypertension Research
Vol/bind	34
Sider (fra-til)	714-721
ISSN	0916-9636
DOI	https://doi.org/10.1038/hr.2011.6 https://doi.org/10.1038/hr.2011.6
Status	Udgivet - jun. 2011

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Sehestedt, T., Hansen, T. W., Li, Y., Richart, T., Boggia, J., Kikuya, M., Thijs, L., Stolarz-Skrzypek, K., Casiglia, E., Tikhonoff, V., Malyutina, S., Nikitin, Y., Björklund-Bodegård, K., Kuznetsova, T., Ohkubo, T., Lind, L. S., Torp-Pedersen, C., Jeppesen, J., Ibsen, H., ... Jeppesen, J. L. (2011). Are blood pressure and diabetes additive or synergistic risk factors? outcome in 8494 subjects randomly recruited from 10 populations. Hypertension Research, 34, 714-721. https://doi.org/10.1038/hr.2011.6, https://doi.org/10.1038/hr.2011.6

Sehestedt, T, Hansen, TW, Li, Y, Richart, T, Boggia, J, Kikuya, M, Thijs, L, Stolarz-Skrzypek, K, Casiglia, E, Tikhonoff, V, Malyutina, S, Nikitin, Y, Björklund-Bodegård, K, Kuznetsova, T, Ohkubo, T, Lind, LS, Torp-Pedersen, C, Jeppesen, J, Ibsen, H, Imai, Y, Wang, J, Sandoya, E, Kawecka-Jaszcz, K, Staessen, JA & Jeppesen, JL 2011, 'Are blood pressure and diabetes additive or synergistic risk factors? outcome in 8494 subjects randomly recruited from 10 populations', Hypertension Research, bind 34, s. 714-721. https://doi.org/10.1038/hr.2011.6, https://doi.org/10.1038/hr.2011.6

@article{c8d9fa50fa6c4e3d879c870af00e70ba,

title = "Are blood pressure and diabetes additive or synergistic risk factors? outcome in 8494 subjects randomly recruited from 10 populations",

abstract = "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, 0.07P0.97). The only exception was a borderline synergistic effect between diabetes and daytime diastolic BP in relation to the composite cardiovascular endpoint (P0.04). 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, 0.09P0.72). 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.",

author = "Thomas Sehestedt and Hansen, {Tine W} and Yan Li and Tom Richart and Jose Boggia and Masahiro Kikuya and Lutgarde Thijs and Katarzyna Stolarz-Skrzypek and Edoardo Casiglia and Val{\'e}rie Tikhonoff and Sofia Malyutina and Yuri Nikitin and Kristina Bj{\"o}rklund-Bodeg{\aa}rd and Tatiana Kuznetsova and Takayoshi Ohkubo and Lind, {Lars Solskov} and Christian Torp-Pedersen and J{\o}rgen Jeppesen and Hans Ibsen and Yutaka Imai and Jiguang Wang and Edgardo Sandoya and Kalina Kawecka-Jaszcz and Staessen, {Jan A} and Jeppesen, {J{\o}rgen Lykke}",

year = "2011",

month = jun,

doi = "10.1038/hr.2011.6",

language = "English",

volume = "34",

pages = "714--721",

journal = "Hypertension Research",

issn = "0916-9636",

publisher = "nature publishing group",

}

TY - JOUR

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 - 2011/6

Y1 - 2011/6

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, 0.07P0.97). The only exception was a borderline synergistic effect between diabetes and daytime diastolic BP in relation to the composite cardiovascular endpoint (P0.04). 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, 0.09P0.72). 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.

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, 0.07P0.97). The only exception was a borderline synergistic effect between diabetes and daytime diastolic BP in relation to the composite cardiovascular endpoint (P0.04). 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, 0.09P0.72). 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.

U2 - 10.1038/hr.2011.6

DO - 10.1038/hr.2011.6

M3 - Journal article

C2 - 21307869

SN - 0916-9636

VL - 34

SP - 714

EP - 721

JO - Hypertension Research

JF - Hypertension Research

ER -

Are blood pressure and diabetes additive or synergistic risk factors? outcome in 8494 subjects randomly recruited from 10 populations

Abstract

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