THE INCIDENCE OF HYPERTENSION IN INSULIN-DEPENDENT DIABETES

Background: There are few epidemiologic data describing the long-term incidence of hypertension in people with diabetes. Methods: In a popul ation-based study performed in southern Wisconsin, 765 individuals dia gnosed as having diabetes when they were younger than 30 years and tak ing insulin participated in baseline, 4-year, and 10-year examinations . Blood pressure was measured by standardized protocols, and hypertens ion was defined as a mean systolic blood pressure of 160 mm Hg or more (greater than or equal to 140 mm Hg in those younger than 25 years) a nd/or mean diastolic blood pressure of 95 mm Hg or more (greater than or equal to 90 mm Hg in those younger than 25 years) and/or history of hypertension with the use of antihypertensive medication. Results: Th e prevalence of hypertension at baseline was 17.3%. The 10-year incide nce of hypertension was 25.9%. The incidence of hypertension was great er with older age, longer duration of diabetes, higher glycosylated he moglobin level, proteinuria, more severe retinopathy, and male gender. After other risk factors were controlled for, the 10-year incidence o f hypertension was significantly related to higher glycosylated hemogl obin level (odds ratio, 1.23 per percentage increase; 95% confidence i nterval, 1.13 to 1.34), presence of gross proteinuria (adds ratio, 3.6 3; 95% confidence interval, 2.26 to 5.85),longer duration of diabetes (odds ratio, 1.03 per year of diabetes; 95% confidence interval, 1.01 to 1.04), and being male (odds ratio, 1.93; 95% confidence interval, 1 .34 to 2.77). Conclusion: These data suggest that control of hyperglyc emia and prevention of gross proteinuria may lead to a reduction in th e long-term incidence of hypertension.