Special Focus Issue: Population Health Promotion
Original Investigation
Usual Blood Pressure and Risk of New-Onset Diabetes: Evidence From 4.1 Million Adults and a Meta-Analysis of Prospective Studies

https://doi.org/10.1016/j.jacc.2015.07.059Get rights and content
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Abstract

Background

Reliable quantification of the association between blood pressure (BP) and risk of type 2 diabetes is lacking.

Objectives

This study sought to determine the association between usual BP and risk of diabetes, overall and by participant characteristics.

Methods

A cohort of 4.1 million adults, free of diabetes and cardiovascular disease, was identified using validated linked electronic health records. Analyses were complemented by a meta-analysis of prospective studies that reported relative risks of new-onset diabetes per unit of systolic blood pressure (SBP).

Results

Among the overall cohort, 20 mm Hg higher SBP and 10 mm Hg higher diastolic BP were associated with a 58% and a 52% higher risk of new-onset diabetes (hazard ratio: 1.58; 95% confidence interval [CI]: 1.56 to 1.59; and hazard ratio: 1.52; 95% confidence interval: 1.51 to 1.54), respectively. There was no evidence of a nadir to a baseline BP of 110/70 mm Hg. The strength of the association per 20 mm Hg higher SBP declined with age and with increasing body mass index. Estimates were similar even after excluding individuals prescribed antihypertensive or lipid-lowering therapies. Systematic review identified 30 studies with 285,664 participants and 17,388 incident diabetes events. The pooled relative risk of diabetes for a 20 mm Hg higher usual SBP across these studies was 1.77 (1.53 to 2.05).

Conclusions

People with elevated BP are at increased risk of diabetes. The strength of the association declined with increasing body mass index and age. Further research should determine if the observed risk is modifiable.

Key Words

body mass index
meta-analysis
regression dilution bias

Abbreviations and Acronyms

BMI
body mass index
BNF
British National Formulary
BP
blood pressure
CPRD
Clinical Research Practice Datalink
DBP
diastolic blood pressure
HR
hazard ratio
RAS
renin-angiotensin system
SBP
systolic blood pressure

Cited by (0)

The study was funded by the U.K. National Institute for Health Research. No funders or sponsors were involved in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.

Dr. Emdin is supported by the Rhodes Trust. Dr. Anderson is an Academic Clinical Lecturer in Cardiology and is funded by the National Institute of Health Research. Dr. Woodward is supported by a Principal Research Fellowship from the Australian Health and Medical Research Council; and is a consultant for Amgen and Novartis. The work of The George Institute is supported by the Oxford Martin School. Dr. Rahimi is supported by the National Institute of Health Research Oxford Biomedical Research Centre and National Institute of Health Research Career Development Fellowship.

Listen to this manuscript's audio summary by JACC Editor-in-Chief Dr. Valentin Fuster.