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Conversion of IGT to type 2 diabetes mellitus is associated with incident cases of hypertension: a post-hoc analysis of the STOP-NIDDM trial

Hanefeld, Markolfa; Pistrosch, Franka,b; Koehler, Carstaa; Chiasson, Jean Louisc

doi: 10.1097/HJH.0b013e328354663c
ORIGINAL PAPERS: Obesity and diabetes
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Background: Type 2 diabetes mellitus and hypertension are closely associated and contribute together to microvascular and macrovascular end-organ damage. Prevalence of hypertension is increased even in the prediabetic state. However, there is little information available about the relationship between incidence of hypertension and a deterioration of glucose tolerance from impaired glucose tolerance (IGT) to diabetes.

Methods: To clarify these issues we analysed data from the Stop non insulin dependent diabetes mellitus (STOP-NIDDM) trial – a prospective interventional study for the prevention of type 2 diabetes in people with prediabetes using the alpha-glucosidase inhibitor acarbose. Hypertension was already present at study entry in 702 (51.3%) of 1368 patients who were eligible for intention-to-treat analysis.

Results: A total of 96 out of the 666 normotensive individuals at baseline developed hypertension during the 3.3-year follow-up. The strongest risk factors for time to development of hypertension were abdominal obesity at baseline [hazard ratio 1.91, 95% confidence interval (CI) 1.19–3.05, P < 0.01] and worsening of glucose tolerance (hazard ratio 1.54, 95% CI 1.02–2.32, P < 0.05), whereas acarbose treatment reduced the risk of hypertension (hazard ratio 0.59, 95% CI 0.39–0.90, P < 0.05).

Conclusion: A significant relationship was found between the development of type 2 diabetes and hypertension in patients with IGT, and treatment with acarbose, which primarily improved postprandial hyperglycaemia, reduced the incidence of hypertension as well as diabetes. This suggests that the two entities shared ‘common soil’.

aCenter for Clinical Studies, Technical University Dresden

bNephrology, Department of Medicine, Universitätsklinik Carl Gustav Carus, Dresden, Germany

cDivision of Endocrinology-Nutrition and Metabolism, Centre hospitalier de l’Université de Montréal, Québec, Canada

Correspondence to Frank Pistrosch, GWT TU Dresden GmbH, Fiedlerstr. 34, 01307 Dresden, Germany. Tel: +49 351 4400580; e-mail: frankpistrosch@hotmail.com

Abbreviations: HOMA-IR, Homeostasis Model Assessment for Insulin Resistance; IGT, impaired glucose tolerance; NGT, normal glucose tolerance; ROS, reactive oxygen species

Received 31 October, 2011

Revised 10 February, 2012

Accepted 3 April, 2012

© 2012 Lippincott Williams & Wilkins, Inc.