Hypertension in diet versus pharmacologically treated diabetics - Mortality over a 5-year follow-up

The natural history of non-insulin-dependent diabetes mellitus (NIDDM) diff ers markedly between patients with diet treated and pharmacologically treat ed disease. However, the interrelationship between hypertension and these c ommon diabetes types has not been specifically addressed in previous studie s. This study was designed to evaluate the prognostic significance and prev alence of hypertension in coronary patients with diet versus pharmacologica lly treated NIDDM over a 5-year follow-up period. The study sample comprise d 11 515 patients aged 45 to 74 years with a previous myocardial infarction and/or anginal syndrome who had been screened but were not included in the Bezafibrate Infarction Prevention study. Among them, 9033 were nondiabetic s and 2482, diabetics (987 diet treated and 1495 pharmacologically treated) . The prevalence of hypertension among nondiabetics, diet-treated diabetics , and pharmacologically treated diabetics was 31%, 42%, and 43%, respective ly. Crude all-cause mortality (CM) was lower in the nondiabetic patients (1 1.2% versus 22.0%; P < 0.001). Among diabetics, 548 patients died: 81 diet treated normotensives (CM 14%); 100 diet-treated hypertensives (CM 24.4%); 205 pharmacologically treated normotensives (CM 24.2%); and 162 pharmacolog ically treated hypertensive patients (CM 25.0%). Age-adjusted mortality was lowest for the normotensive patients in the diet-treated group and highest for the hypertensive pharmacologically treated patients, Multivariate anal ysis shows that hypertension is a strong and independent predictor of incre ased CM in diet-treated but not in pharmacologically treated NIDDM: hazard ratio (HR) was 1.68 (95% confidence interval [CI] 1.24 to 2.29) for the die t-treated versus 1.01 (95% CI 0.82 to 1.26) for the pharmacologically treat ed diabetics, The contribution of hypertension to stroke mortality was subs tantial for both diet treated and pharmacologically treated NIDDM: hazard r atios were 3.17 (95% CI 1.12 to 8.98) and 2.21 (95% CI 0.72 to 6.77), respe ctively. The increased risk of mortality associated with hypertension in re latively mild diet-treated NIDDM strongly supports the clinical benefit of early blood pressure control among diabetic patients with ischemic heart di sease.