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The association between fasting plasma glucose and glycated hemoglobin in the prediabetes range and future development of hypertension.
Cardiovasc Diabetol. 2019 04 27; 18(1):53.CD

Abstract

BACKGROUND

Prediabetes is a well-established risk factor for progression to overt diabetes mellitus (DM), which is in turn associated with development of hypertension (HTN) and vice versa. However, the role of prediabetes and HbA1c in particular as an independent risk factor for the development of hypertension is unclear.

AIM

In this current study, we aimed to evaluate the association between both fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) levels in the prediabetes range and development of HTN among a large cohort of normotensive subjects.

DESIGN AND METHODS

We investigated 5016 normotensive participants without DM and other cardiovascular risk factors who were annually screened in a tertiary medical center. Subjects were divided into normoglycemic and prediabetic groups. Normoglycemia was defined as HbA1c < 5.7% and FPG < 100 mg/dl. Prediabetes was defined according to the ADA criteria, i.e., 6.5% > HbA1c ≥ 5.7% or impaired fasting glucose (IFG):126 mg/dl > FPG ≥ 100 mg/dl. Subgroup analysis was made by dividing participants into four groups according to FPG and HbA1C levels, i.e., normoglycemia, impaired HbA1c only, IFG only, and both parameters impaired.

RESULTS

During a follow-up of 3.7 ± 2.9 years, 318 (6.3%) subjects developed HTN. A cumulative hazard function for the development of hypertension showed a 2.89-fold ([95% CI 2.19-3.83], p < .0001) increased risk for HTN in the prediabetic population. In a multivariable Cox proportional hazard regression model adjusted to common confounding risk factors for HTN, prediabetes was found to be independently associated with a 1.95-fold ([95%, CI 1.43-2.52] p < .0001) increased risk for hypertension. Impaired HbA1C only was not found to be independently associated with HTN, while IFG only showed a 2.13-fold (95%, [CI 1.46-3.11] p < .0001) increased risk for HTN compared to normoglycemic, and a 2.55-fold ([95% CI 1.85-3.51] p < .0001) increased risk for HTN when both parameters impaired.

CONCLUSION

Our study demonstrates that FPG in the prediabetes range, albeit not glycated hemoglobin, is independently and significantly associated with future development of HTN. Therefore, our findings further highlight the pivotal predictive role of IFG for HTN development as opposed to the limited independent role of abnormal HbA1c levels.

Authors+Show Affiliations

Department of Internal Medicine D, Chaim Sheba Medical Center, Ramat Gan, Israel. Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel.Department of Internal Medicine D, Chaim Sheba Medical Center, Ramat Gan, Israel. Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel.Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel. Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel.Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel. Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel.Department of Internal Medicine D, Chaim Sheba Medical Center, Ramat Gan, Israel. Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel.Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel. Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel.Department of Internal Medicine D, Chaim Sheba Medical Center, Ramat Gan, Israel. Ehud.Grossman@sheba.health.gov.il. Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel. Ehud.Grossman@sheba.health.gov.il.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31029146

Citation

Geva, Mika, et al. "The Association Between Fasting Plasma Glucose and Glycated Hemoglobin in the Prediabetes Range and Future Development of Hypertension." Cardiovascular Diabetology, vol. 18, no. 1, 2019, p. 53.
Geva M, Shlomai G, Berkovich A, et al. The association between fasting plasma glucose and glycated hemoglobin in the prediabetes range and future development of hypertension. Cardiovasc Diabetol. 2019;18(1):53.
Geva, M., Shlomai, G., Berkovich, A., Maor, E., Leibowitz, A., Tenenbaum, A., & Grossman, E. (2019). The association between fasting plasma glucose and glycated hemoglobin in the prediabetes range and future development of hypertension. Cardiovascular Diabetology, 18(1), 53. https://doi.org/10.1186/s12933-019-0859-4
Geva M, et al. The Association Between Fasting Plasma Glucose and Glycated Hemoglobin in the Prediabetes Range and Future Development of Hypertension. Cardiovasc Diabetol. 2019 04 27;18(1):53. PubMed PMID: 31029146.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The association between fasting plasma glucose and glycated hemoglobin in the prediabetes range and future development of hypertension. AU - Geva,Mika, AU - Shlomai,Gadi, AU - Berkovich,Anat, AU - Maor,Elad, AU - Leibowitz,Avshalom, AU - Tenenbaum,Alexander, AU - Grossman,Ehud, Y1 - 2019/04/27/ PY - 2019/02/05/received PY - 2019/04/18/accepted PY - 2019/4/29/entrez PY - 2019/4/29/pubmed PY - 2019/6/14/medline KW - Cardiovascular risk KW - HbA1c KW - Hypertension KW - Impaired fasting glucose KW - Insulin resistance KW - Prediabetes SP - 53 EP - 53 JF - Cardiovascular diabetology JO - Cardiovasc Diabetol VL - 18 IS - 1 N2 - BACKGROUND: Prediabetes is a well-established risk factor for progression to overt diabetes mellitus (DM), which is in turn associated with development of hypertension (HTN) and vice versa. However, the role of prediabetes and HbA1c in particular as an independent risk factor for the development of hypertension is unclear. AIM: In this current study, we aimed to evaluate the association between both fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) levels in the prediabetes range and development of HTN among a large cohort of normotensive subjects. DESIGN AND METHODS: We investigated 5016 normotensive participants without DM and other cardiovascular risk factors who were annually screened in a tertiary medical center. Subjects were divided into normoglycemic and prediabetic groups. Normoglycemia was defined as HbA1c < 5.7% and FPG < 100 mg/dl. Prediabetes was defined according to the ADA criteria, i.e., 6.5% > HbA1c ≥ 5.7% or impaired fasting glucose (IFG):126 mg/dl > FPG ≥ 100 mg/dl. Subgroup analysis was made by dividing participants into four groups according to FPG and HbA1C levels, i.e., normoglycemia, impaired HbA1c only, IFG only, and both parameters impaired. RESULTS: During a follow-up of 3.7 ± 2.9 years, 318 (6.3%) subjects developed HTN. A cumulative hazard function for the development of hypertension showed a 2.89-fold ([95% CI 2.19-3.83], p < .0001) increased risk for HTN in the prediabetic population. In a multivariable Cox proportional hazard regression model adjusted to common confounding risk factors for HTN, prediabetes was found to be independently associated with a 1.95-fold ([95%, CI 1.43-2.52] p < .0001) increased risk for hypertension. Impaired HbA1C only was not found to be independently associated with HTN, while IFG only showed a 2.13-fold (95%, [CI 1.46-3.11] p < .0001) increased risk for HTN compared to normoglycemic, and a 2.55-fold ([95% CI 1.85-3.51] p < .0001) increased risk for HTN when both parameters impaired. CONCLUSION: Our study demonstrates that FPG in the prediabetes range, albeit not glycated hemoglobin, is independently and significantly associated with future development of HTN. Therefore, our findings further highlight the pivotal predictive role of IFG for HTN development as opposed to the limited independent role of abnormal HbA1c levels. SN - 1475-2840 UR - https://www.unboundmedicine.com/medline/citation/31029146/The_association_between_fasting_plasma_glucose_and_glycated_hemoglobin_in_the_prediabetes_range_and_future_development_of_hypertension_ L2 - https://cardiab.biomedcentral.com/articles/10.1186/s12933-019-0859-4 DB - PRIME DP - Unbound Medicine ER -