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. 2010 May;33(5):1122-7.
doi: 10.2337/dc09-1447. Epub 2010 Feb 25.

Is pulse pressure a predictor of new-onset diabetes in high-risk hypertensive patients?: a subanalysis of the Candesartan Antihypertensive Survival Evaluation in Japan (CASE-J) trial

Shinji Yasuno  1 , Kenji Ueshima, Koji Oba, Akira Fujimoto, Masakazu Hirata, Toshio Ogihara, Takao Saruta, Kazuwa Nakao
Affiliations

Is pulse pressure a predictor of new-onset diabetes in high-risk hypertensive patients?: a subanalysis of the Candesartan Antihypertensive Survival Evaluation in Japan (CASE-J) trial

Shinji Yasuno et al. Diabetes Care. 2010 May.

Abstract

Objective: Hypertensive patients have an increased risk of developing diabetes. Accumulating evidence suggests a close relation between metabolic disturbance and increased arterial stiffness. Here, we examined the association between pulse pressure and the risk of new-onset diabetes in high-risk Japanese hypertensive patients.

Research design and methods: The Candesartan Antihypertensive Survival Evaluation in Japan (CASE-J) trial examined the effects of candesartan and amlodipine on the incidence of cardiovascular events in 4,728 high-risk Japanese hypertensive patients. In the present study, we analyzed the relationship between pulse pressure at baseline and new-onset diabetes in 2,685 patients without diabetes at baseline (male 1,471; mean age 63.7 years; mean BMI 24.8 kg/m(2)) as a subanalysis of the CASE-J trial.

Results: During 3.3 +/- 0.8 years of follow-up, 97 patients (3.6%) developed diabetes. In multiple Cox regression analysis, pulse pressure was an independent predictor for new-onset diabetes (hazard ratio [HR] per 1 SD increase 1.44 [95% CI 1.15-1.79]) as were male sex, BMI, and additional use of diuretics, whereas age and heart rate were not. Plots of HRs for new-onset diabetes considering both systolic and diastolic blood pressure (DBP) revealed that a higher pulse pressure with a lower DBP, indicating that the increased pulse pressure was largely due to increased arterial stiffness, was strongly associated with the risk of new-onset diabetes.

Conclusions: Pulse pressure is an independent predictor of new-onset diabetes in high-risk Japanese hypertensive patients. Increased arterial stiffness may be involved in the development of diabetes.

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Figures

Figure 1
Figure 1
Risk of new-onset diabetes by SBP and DBP at enrollment. HR of DBP of 90 mmHg in the SBP <160 mmHg category was assigned a reference value of 1.0.
Figure 2
Figure 2
Effect of candesartan and amlodipine on the incidence of new-onset diabetes stratified by quartile of PPf. PPf (linear and quadratic terms), the allocated drugs, and their interaction terms were entered in multiple Cox regression model. P value was calculated based on the Wald test.
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