Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Sep 28:2021:9977840.
doi: 10.1155/2021/9977840. eCollection 2021.

Impact of Novel Guidelines on Multifactorial Control and Its Association with Mortality in Adult Patients with Hypertension and Newly Diagnosed Type 2 Diabetes: A 4-Year Prospective Multicenter Study

Ngoc-Thanh-Van Nguyen  1   2   3 , Hoa Ngoc Chau  1   2   3 , Nam Hoai Le  1   3 , Hai Hoang Nguyen  2 , Hoai-An Nguyen  4
Affiliations

Impact of Novel Guidelines on Multifactorial Control and Its Association with Mortality in Adult Patients with Hypertension and Newly Diagnosed Type 2 Diabetes: A 4-Year Prospective Multicenter Study

Ngoc-Thanh-Van Nguyen et al. Int J Endocrinol. .

Abstract

Methods: This prospective, observational study involved adult hypertensive patients with newly diagnosed type 2 diabetes mellitus at two university hospitals in Vietnam. The median time of follow-up was 4 years (August 2016-August 2020). The primary outcome was time to all-cause mortality.

Results: 246 patients were included with a mean age of 64.5 ± 10.4. 58.5% were females. 64.2% were categorized as high risk. At baseline, ischemic heart disease, dyslipidemia, and chronic kidney disease (CKD) were present in 54.9%, 67.1%, and 41.1% of patients. Renin-angiotensin-aldosterone inhibitor, metformin, and statin were prescribed in 89.8%, 66.3%, and 67.1%. Among three risk factors, LDL-c control was the hardest to achieve, increasing from 5.7% to 8.5%. In contrast, blood pressure control decreased from 56.1% in 2016 to 30.2% in 2020, when the second wave of COVID-19 hit our nation. While contemporary targets resulted in persistently low simultaneous control at 1.2%, significant improvement was observed with conventional criteria (blood pressure < 140/90 mmHg, HbA1c < 7%, LDL-c < 70 mg/dl), increasing from 14.6% to 33.7%. During follow-up, the mortality rate was 24.4 events per 1000 patient-years, exclusively in patients with early newly diagnosed diabetes. Improving control overtime, not at baseline, was associated with less mortality. Conversely, age >75 years (HR = 2.6) and CKD (HR = 4.9) were associated with increased mortality.

Conclusion: These findings demonstrated real-world difficulties in managing hypertension and newly diagnosed diabetes, especially with stringent criteria from novel guidelines. High-risk profile, high mortality, and poor simultaneous control warrant more aggressive cardiorenal protection, focusing more on aging CKD patients with early newly diagnosed diabetes.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Flow diagram of the study procedure and patient selection. eGFR: estimated Glomerular Filtration Rate; ALT: alanine transaminase; AST: aspartate transaminase; IC: informed consent; PFG: fasting plasma glucose; PPG: postprandial plasma glucose; HbA1c: glycated hemoglobin.
Figure 2
Figure 2
Change in the number of controlled risk factors overtime.
Figure 3
Figure 3
Kaplan–Meier curve for all-cause mortality in patients with and without two to three risk factors' control at final follow-up.
Figure 4
Figure 4
Changes in risk factor control and time to all-cause mortality in patients with hypertension and newly diagnosed diabetes.
Figure 5
Figure 5
Multivariable Cox analysis of factors associated with all-cause mortality in patients with hypertension and newly diagnosed diabetes after 4 years.
Figure 6
Figure 6
Kaplan–Meier for all-cause mortality in patients with and without CKD and age>75 or <75 years.
See this image and copyright information in PMC

References

    1. Katherine T., Bundy J. D., Kelly T. N., et al. Global disparities of hypertension prevalence and control: a systematic analysis of population-based studies from 90 countries. Circulation . 2016;134(6):441–450. doi: 10.1161/CIRCULATIONAHA.115.018912. - DOI - PMC - PubMed
    1. Forouzanfar M. H., Liu P., Roth G. A, et al. Global burden of hypertension and systolic blood pressure of at least 110 to 115 mm Hg, 1990-2015. Journal of the American Medical Association . 2017;317(2):165–182. doi: 10.1001/jama.2016.19043. - DOI - PubMed
    1. Geldsetzer P., Manne-Goehler J., Marcus M.-E., et al. The state of hypertension care in 44 low-income and middle-income countries: a cross-sectional study of nationally representative individual-level data from 1·1 million adults. The Lancet . 2019;394(10199):652–662. doi: 10.1016/s0140-6736(19)30955-9. - DOI - PubMed
    1. Zhou B., Danaei G., Stevens G. A., Bixby H. Long-term and recent trends in hypertension awareness, treatment, and control in 12 high-income countries: an analysis of 123 nationally representative surveys. Lancet (London, England) . 2019;394(10199):639–651. doi: 10.1016/S0140-6736(19)31145-6. - DOI - PMC - PubMed
    1. Nambiar L., LeWinter M. M., VanBuren P. C., Dauerman H. L. Decade-long temporal trends in U.S. Hypertension-related cardiovascular mortality. Journal of the American College of Cardiology . 2020;75(20):2644–2646. doi: 10.1016/j.jacc.2020.03.009. - DOI - PubMed

LinkOut - more resources