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Arterial Stiffness May Best Hypertension for Predicting Diabetes Risk in Chinese Patients

NEW YORK (Reuters Health) – Both hypertension and arterial stiffness (AS) are associated with diabetes, and AS may be a better risk predictor, an analysis of a Chinese cohort study suggests.

“We think brachial-ankle pulse wave velocity measurement should be a routine examination in future clinical practice,” Dr. Anxin Wang of Beijing Tiantan Hospital in China told Reuters Health by email.

However, he acknowledged, “Our study was conducted among Chinese, thus the findings may not be generalized to other ethnicities.”

As reported in Hypertension, Dr. Wang and colleagues analyzed data from 11,156 participants in the ongoing Kailuan study (, which included more than 22,000. The mean age varied from 45-58 years, and subgroups based on baseline characteristics (e.g., AS, hypertension) ranged from 35%-78% male.

The team compared the risk of diabetes between individuals with ideal vascular function (defined as normotension with normal AS); normotension with elevated AS; hypertension with normal AS; and hypertension with elevated AS.

After a median follow-up of about six years, 768 participants were diagnosed with diabetes.

Compared with the ideal vascular function group, the highest risk of diabetes was seen in the hypertension with elevated AS group (hazard ratio, 2.42), followed by normotension with elevated AS (HR, 2.11); the hypertension with normal AS group had the lowest diabetes risk (HR, 1.48).

Multiple sensitivity and subgroup analyses yielded similar results. Furthermore, the addition of AS to a conventional model including traditional risk factors had a higher incremental effect on the predictive value for diabetes than the addition of hypertension (C statistics were 0.707 vs. 0.695; the integrated discrimination improvement was 0.65% vs. 0.28%; and the net reclassification improvement was 40.48% vs. 34.59%).

The authors write, “Diabetes is associated with not only hypertension but also AS. Additionally, AS shows a better predictive ability than hypertension in predicting diabetes…Combination control of hypertension and AS may help reduce the risk of diabetes.”

Dr. Wang said, “In our future investigations, we would like to assess whether AS control is useful in the prevention of diabetes, and we also would like to assess methods of AS control.”

Dr. Ajaykumar Rao, Research Director of the Temple Comprehensive Hypertension Program at the Temple Heart and Vascular Institute and Associate Professor of Medicine at the Lewis Katz School of Medicine at Temple University in Philadelphia called the findings “very interesting.”

“However,” he told Reuters Health by email, “the real-world clinical applicability of this study is hard to assess until we have a robust and population-wide method to easily measure AS.”

“Further,” he said, “the authors make limited commentary on the diet of the individuals who participated in the study, namely salt balance. There are also many hormones implicated in the connection between diet, hypertension, and diabetes – e.g., aldosterone – which are not mentioned in this study at all.”

In addition, he added, “This is an analysis within a larger study, and the authors themselves note that there were differences between those who were included and excluded from this specific sub-study.”

“Moreover, a common test for diagnosis of diabetes (HbA1c) was not measured in this study,” he said. “It would be important to consider this metric in any design of a future study. Finally, a proper study would include assessment of socioeconomic status of the study participants.”

“Clearly, there is an evolving connection between hypertension and diabetes,” Dr. Rao noted. “This potential connection needs to be identified sooner when screening patients for either entity. Hopefully in the near future, we will have a clinically useful tool to measure AS, which may precede the development of hypertension and/or diabetes.”

SOURCE: Hypertension, online May 16, 2022.

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