Predictors of new-onset diabetes mellitus in hypertensive patients: the VALUE trial

Abstract

Diabetes mellitus often develops in patients with hypertension. We investigated predictors of diabetes mellitus development in hypertensives at risk of developing the disease in the VALUE trial population. Among the 9995 non-diabetic hypertensive patients at baseline, 1298 patients developed diabetes mellitus during the average follow-up of 4.2 years. New-onset diabetes mellitus was defined from adverse event reports, information about new antidiabetic medication and/or a fasting glucose X7.0 mmol l À1 at the end of trial. Twentyfive potential baseline predictors of new-onset diabetes mellitus were analysed by univariate logistic regression and 14 of 25 predictors were found to be statistically significant with a P-value o0.05. The predictors were in order of decreasing significance; glucose, body mass index (BMI), age, uric acid, non-Caucasian race, haemoglobin, heart rate, randomized study treatment, history of coronary heart disease (CHD), gender, total cholesterol, proteinuria, potassium and creatinine. Multivariate stepwise logistic regression analyses were used and potential baseline predictors of new-onset diabetes mellitus were considered significant by four different models (P-value o0.001). The final multivariate model selected included all patients, but not treatment group as a potential predictor, and the six significant predictors identified from this model were glucose, BMI, non-Caucasian race, age, heart rate and history of CHD. In conclusion, glucose and BMI were the most important predictors of new-onset diabetes mellitus in hypertensive patients at high cardiovascular risk, and easily accessible clinical characteristics strongly predict patients at risk of developing diabetes mellitus.

Resting heart rate and the risk of type 2 diabetes: A systematic review and dose–response meta-analysis of cohort studies

“…Despite this, the association between elevated resting heart rate and type 2 diabetes remains unclear (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). Some studies suggested an increased risk of type 2 diabetes with higher heart rate (6;7;10;12-17), whereas others found the association to be no longer significant after adjustment for potential confounding factors (8;9;11).…”

Hypertension and diabetes incidence: confounding factors

“…Different antihypertensive treatments seems to have different impacts on diabetes incidence, and in particular, the RAAS modulating agents appear to have a protective role against diabetes development. [2][3][4] It is also possible that common genetic patterns could influence both HTN and diabetes incidence. The environmental causes of these diseases are actually well known.…”

“…2 However, in the large Valsartan Antihypertensive Long-term Use Evaluation trial, in which 9995 patients were enrolled with 1298 cases of incident diabetes, HTN was not a significant predictor of diabetes. 3 The physiopathological link between HTN and diabetes in lean subjects primarily involves the renin-angiotensin-aldosterone system (RAAS). This hypothesis is supported by numerous preclinical tests and by the results of some large clinical trials.…”

The effect of antihypertensive agents in people at high risk of cardiovascular disease and diabetes: a view through smoke and mirrors

“…21 Pretreatment plasma glucose is by far the most important predictor of new-onset diabetes. 22,23 In various populations, there is a continuous relationship between plasma glucose or HbA lc and cardiovascular outcomes, even at levels below the threshold for diabetes. [24][25][26] Thus, the excess risk of cardiovascular events in new-onset diabetes may be associated with plasma glucose status long before the diagnoses or the introduction of therapy.…”