Prevalence and prognostic significance of unrecognized systemic hypertension in patients with diabetes mellitus and healed myocardial infarction and/or stable angina pectoris

Few data are available regarding the prevalence and prognostic significance of the triple coexistence of undiagnosed systemic hypertension, diabetes m ellitus, and coronary heart disease. This study aimed to evaluate the preva lence and prognostic significance of unrecognized hypertension in cardiac d iabetic patients previously defined as "normotensives" over a 5-year follow -up period. The study sample comprised 11,515 patients aged 45 to 74 years with a previous myocardial infarction and/or anginal syndrome who were scre ened but not included in the Bezafibrate Infarction prevention study. Among them, 9,033 were nondiabetics and 2,482, diabetics. The diabetics were div ided into 3 groups: (1) 1,272 normotensives, (2) 152 patients without histo ry of hypertension but with elevated blood pressure ("unrecognized hyperten sives"), and (3) 1,058 hypertensives with established diagnosis. The preval ence of both diagnosed and unrecognised hypertension in diabetics pooled to gether increased from 49% to 69% when World Health Organization and new Joi nt National Committee-VI criteria were compared. Crude all-cause mortality was lower in nondiabetics than in diabetics (11.2% vs 22.0%; p <0.001). Amo ng diabetics the lowest all-cause mortality was documented for normotensive s (19.3%), whereas the highest mortality was observed in unrecognized hyper tensives (26.3%, p 0.003). Both unrecognized and established hypertensives demonstrated a significant stroke-related mortality excess: about four- and threefold increases in cerebrovascular accident-related death, respectivel y, were observed (p = 0.002). On multivariate analysis, both unrecognized a nd diagnosed hypertension were consistent predictors of increased all-cause mortality, with a hazard ratio of 1.28 (95% confidence interval 0.90 to 1. 82) and 1.24 (95% confidence interval 1.03 to 1.49), respectively. Our find ings demonstrate widespread undiagnosed hypertension in diabetic coronary p atients; their 5-year mortality was significantly increased compared with n ormotensives, and tended to be even higher than in diabetics previously ide ntified as hypertensives. (C) 1999 by Excerpta Medica, Inc.