Hypertension and Diabetes Mellitus: Coprediction and Time Trajectories

Abstract

Type 2 diabetes mellitus and hypertension overlap in the population. In many subjects, development of diabetes mellitus
is characterized by a relatively rapid increase in plasma glucose values. Whether a similar phenomenon occurs during
the development of hypertension is not known. We analyzed the pattern of blood pressure (BP) changes during the
development of hypertension in patients with or without diabetes mellitus using data from the MCDS and in the FOS
during a 7-year follow-up. Diabetes mellitus at baseline was a significant predictor of incident hypertension (in FOS,
odds ratio, 3.14; 95% confidence interval, 2.17–4.54) independently of sex, age, body mass index, and familial diabetes
mellitus. Conversely, hypertension at baseline was an independent predictor of incident diabetes mellitus. In comparison
with the nonconverters group, hypertension and diabetes mellitus converters shared a metabolic syndrome phenotype
(hyperinsulinemia, higher body mass index, waist girth, BP, heart rate and pulse pressure, and dyslipidemia). Overall,
results were similar in the 2 ethnic groups. We conclude that (1) development of hypertension and diabetes mellitus
track each other over time, (2) transition from normotension to hypertension is characterized by a sharp increase in BP
values, and (3) insulin resistance is one common feature of both prediabetes and prehypertension and an antecedent of
progression to 2 respective disease states.