Impact of Hypertension in the Morbidity and Mortality in Diabetes Mellitus: A Real-World Data

Abstract

Objective: To assess the impact of hypertension in the risk of cardiovascular events and mortality in a population of diabetic patients from a Mediterranean population based in Real World Evidence. Design and method: The sample was recruited from beneficiaries of the Valencian Health Agency's health care system, with a population of 3799884 people older than 25 years in 2012. The observational study was undertaken as part of routine clinical practice from January 2012 to December 2016. Diabetes was defined as a non-fasting glucose higher or equal to 200 mg/dl, a recorded physician diagnosis, medication use or an HbA1c higher or equal to 6.5%. Hypertension was defined by a recorded physician diagnosis or antihypertensive medication use. Estimated glomerular filtration rate (eGFR) was calculated from calibrated creatinine, age and sex using the CKD-EPI and CKD was defined when eGFR < 60 ml/min/1.73m2. Vital status was determined by matching records and death certificates from the Spanish National Death Index. Results: Among the total population of 3799884, DM was present in 510922 (13%) patients (12% in women and 15% in men), Average of HbA1c was 6.9% + 1.4%. Hypertension was recorded in 387590 (75%) with a rate of BP < 140/90 mmHg of 45% and CKD in 125441 (24%). The incidence rates for DM, with and without diagnostic of HTN, of acute myocardial infarction, heart failure and stroke, as well all-cause mortality by age and sex rates are in the figure, in which the times of increment of risk due to the presence of HTN is presented. Conclusions: Presence of HTN in patients of diabetes largely increases the risk of MI, stroke, HF and all-cause mortality. The impact even it is higher in more younger patients, it still until the last decade of life.

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