http://hyper.ahajournals.org/cgi/content/full/50/3/467

Abstract

 
There has been a lot of interest about new-onset diabetes mellitus in
recent hypertension trials, but the implications of diabetes development
on cardiac outcomes have not been known. In the Valsartan
Antihypertensive Long-Term Use Evaluation trial, 15 245 high-risk
patients were followed for an average of 4.2 years. At baseline, 5250
patients were diabetic by the 1999 World Health Organization criteria,
and among the 9995 nondiabetic patients, 1298 patients developed
diabetes during follow-up. We have investigated the influence of
diabetes development on outcomes in the Valsartan Antihypertensive
Long-Term Use Evaluation trial. The patients with diabetes at baseline
and new-onset diabetes were compared with patients who did not develop
diabetes by a Cox regression model with adjustment for prespecified
covariates (age, diabetes status, left ventricular hypertrophy, baseline
coronary heart disease, and randomized study treatment). Patients with
diabetes at baseline had the highest cardiac morbidity defined as
myocardial infarction and heart failure with a hazard ratio of 2.20 (95%
CI: 1.95 to 2.49). The patients with new-onset diabetes had
significantly higher cardiac morbidity, especially more congestive heart
failure, than those without diabetes, with a hazard ratio of 1.43 (95%
CI: 1.16 to 1.77). This indicates that patients who develop diabetes
during antihypertensive treatment have cardiac morbidity intermediate
between diabetic subjects and those subjects who never had diabetes and
that it is of importance to find these patients at risk of diabetes
development and optimize lifestyle and medical treatment.

Key Words: congestive heart failure € diabetes mellitus € hypertension €
morbidity € myocardial infarction € stroke