The association between fasting plasma glucose and glycated hemoglobin in the prediabetes range and future development of hypertension

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%, ] 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.

Hypertension and the effect of dietary salt on inflammation: An interventional study

“…Similar to our study ndings, several studies [16][17][18] have reported that fasting blood sugar is a predictor for future incidence of hypertension and is elevated in hypertensive patients. A higher monocyte count is a surrogate for in ammatory processes and a predictor of future hypertension as reported in one study [19].…”

Admission fasting plasma glucose is associated with in-hospital outcomes in patients with acute coronary syndrome and diabetes: findings from the improving Care for Cardiovascular Disease in China - Acute Coronary Syndrome (CCC-ACS) project

“…Discrepancies between HbA 1c and FPG have been reported by some studies. A study of the risk of hypertension in patients with prediabetes demonstrated the discrepancy between HbA 1c and FPG [20]. A study using data from residents of Yunnan Province, China, showed that a discrepancy between HbA 1c and FPG was present in approximately 30% of participants [21].…”

Elevated glycosylated hemoglobin levels and their interactive effects on hypertension risk in nondiabetic Chinese population: a cross-sectional survey

“…In a Japanese cohort study with five years of follow-up, 9,584 individuals were investigated, and elevated expressions of HbA1c were not associated with an increased risk of developing hypertension in the multivariable analysis [41]. An increment in HbA1c level was also reported not to be independently involved in the future development of hypertension among the Israeli population [42]. Kroke et al [43] revealed that there was a nonsignificant relationship between HbA1c and arterial hypertension in nondiabetic participants; nevertheless, arterial hypertension was defined as a BP of 160/95 mmHg or greater.…”