Insulin therapy, hyperglycemia, and hypertension in type 1 diabetes mellitus

Ian H. De Boer, Bryan Kestenbaum, Tessa C. Rue, Michael W Steffes, Patricia A. Cleary, Mark E. Molitch, John M. Lachin, Noel S. Weiss, John D. Brunzell

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)1867-1873
Number of pages7
JournalArchives of Internal Medicine
Volume168
Issue number17
DOIs
StatePublished - Sep 22 2008

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Type 1 Diabetes Mellitus
Hyperglycemia
Insulin
Hypertension
Diabetes Complications
Blood Pressure
Therapeutics
Confidence Intervals
Antihypertensive Agents
Epidemiology
Hemoglobin A
Glycosylated Hemoglobin A
Weight Gain
Albumins
Diabetes Mellitus
Body Mass Index
Glucose

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De Boer, I. H., Kestenbaum, B., Rue, T. C., Steffes, M. W., Cleary, P. A., Molitch, M. E., ... Brunzell, J. D. (2008). Insulin therapy, hyperglycemia, and hypertension in type 1 diabetes mellitus. Archives of Internal Medicine, 168(17), 1867-1873. https://doi.org/10.1001/archinternmed.2008.2

Insulin therapy, hyperglycemia, and hypertension in type 1 diabetes mellitus. / De Boer, Ian H.; Kestenbaum, Bryan; Rue, Tessa C.; Steffes, Michael W; Cleary, Patricia A.; Molitch, Mark E.; Lachin, John M.; Weiss, Noel S.; Brunzell, John D.

In: Archives of Internal Medicine, Vol. 168, No. 17, 22.09.2008, p. 1867-1873.

Research output: Contribution to journalArticle

De Boer, IH, Kestenbaum, B, Rue, TC, Steffes, MW, Cleary, PA, Molitch, ME, Lachin, JM, Weiss, NS & Brunzell, JD 2008, 'Insulin therapy, hyperglycemia, and hypertension in type 1 diabetes mellitus', Archives of Internal Medicine, vol. 168, no. 17, pp. 1867-1873. https://doi.org/10.1001/archinternmed.2008.2
De Boer, Ian H. ; Kestenbaum, Bryan ; Rue, Tessa C. ; Steffes, Michael W ; Cleary, Patricia A. ; Molitch, Mark E. ; Lachin, John M. ; Weiss, Noel S. ; Brunzell, John D. / Insulin therapy, hyperglycemia, and hypertension in type 1 diabetes mellitus. In: Archives of Internal Medicine. 2008 ; Vol. 168, No. 17. pp. 1867-1873.
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abstract = "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.",
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T1 - Insulin therapy, hyperglycemia, and hypertension in type 1 diabetes mellitus

AU - De Boer, Ian H.

AU - Kestenbaum, Bryan

AU - Rue, Tessa C.

AU - Steffes, Michael W

AU - Cleary, Patricia A.

AU - Molitch, Mark E.

AU - Lachin, John M.

AU - Weiss, Noel S.

AU - Brunzell, John D.

PY - 2008/9/22

Y1 - 2008/9/22

N2 - 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.

AB - 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.

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