Improper glycemic control in diabetes patients tied to higher risk of hypertension

The researchers noted that the effect of glycemic control on hypertension was more pronounced in people with depressive symptoms and lower educational attainment. The findings highlight the significance of educational background considerations, vigilant glycemic monitoring, and mental health assessments in managing diabetes patients.

The other meaningful finding of the study was that diabetes with insufficient glycemic control and depressive symptoms had a significantly higher risk of developing hypertension; implying that mental health may influent the association between glycemic control and hypertension.

"Our finding indicates that mental health should be part of diabetes management, and a psychotherapist or psychiatrist should be included in the diabetes management team," the researchers wrote.

Previous studies have shown that diabetes raises the risk of hypertension morbidity, but there is no information on whether this association varied with glycemic control. Shengliang Chen, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China, and colleagues aimed to examine the association between glycemic control and hypertension among middle-aged and older Chinese with diabetes.

For this purpose, the researchers extracted data from the China Health and Retirement Longitudinal Study (CHARLS) between 2011 and 2018. Participants were categorised as having inadequate glycemic control (HbA1c ≥ 7%) and adequate glycemic control (HbA1c < 7%) by combining blood glucose tests and physician’s diagnoses in 2011.

Incident hypertension was determined through self-reported physician diagnoses from 2011 to 2018. The effect of glycemic control on hypertension was examined using Cox proportional hazards regression models.

According to the researchers, the study is the first population-based cohort study to explore the association between glycemic control and hypertension among those with diabetes in China.

The study revealed the following findings:

· Among 436 participants with diabetes in this study, 102 met the glycemic control standard, and 334 had insufficient glycemic control.

· During 7 years of follow-up, 141 individuals developed hypertension.

· Compared with adequate glycemic control, the hazard ratio of inadequate glycemic control on hypertension was 1.54 in the multivariate model.

· The influence of glycemic control on hypertension varied based on educational attainment and the presence of depressive symptoms.

"Although there is no clarity on the mechanisms, the results suggest that the change in HbA1c might play a direct role in raising the blood pressure through other mechanisms that are not entirely produced by weight gain; highlighting the importance of long-term monitoring of HbA1c levels," the researchers concluded.

Reference:

Chen, S., Zhu, Y., Jin, S. et al. Association of glycemic control with hypertension in patients with diabetes: a population-based longitudinal study. BMC Cardiovasc Disord 23, 501 (2023). https://doi.org/10.1186/s12872-023-03478-3