Unrecognized Hypertension in Diabetic Patients With Coronary Disease

Recent studies have shown a wide spreading of undiagnosed and accordingly untreated hypertension. However, scarce data are available regarding the prevalence and prognostic significance of the triple coexistence of undiagnosed hypertension, diabetes and ischemic heart disease. This study was aimed to evaluate the prevalence and prognostic significance of undiagnosed hypertension in cardiac diabetic patients defined previously as "normotensives" over a 5-year follow-up period. 

Methods
The study sample comprised 11515 patients aged 45­74 with a previous myocardial infarction and/or anginal syndrome who were screened but not included in the Bezafibrate Infarction Prevention (BIP) study. Among them, 9033 were nondiabetics and 2482, diabetics. The diabetics were divided into 3 groups: 1) 1272 normotensives; 2) 152 patients without history of hypertension but with elevated blood pressure ("unrecognized hypertensives"); 3) 1058 hypertensives with established diagnosis. 

Results
The prevalence of both diagnosed and unrecognized hypertension in diabetics pooled together rose from 49% to 69% when WHO and new JNC-VI criteria were compared. Crude all-cause mortality was lower in the nondiabetics than in diabetics (11.2% vs. 22.0%; p < 0.001). Among diabetics the lowest all-cause mortality was documented for the normotensives (19.3%), whereas the highest mortality was observed in unrecognized hypertensives (26.3%, p = 0.003). Both unrecognized and established hypertensives demonstrated a significant stroke-related mortality excess: about four-fold and three-fold increased of CVA death was observed, respectively (p = 0.002). On multivariate analysis both unrecognized and diagnosed hypertension were consistent predictors of increased all-cause mortality with a hazard ratio of 1.28 (95% CI 0.90&Acirc;&shy;1.82) and 1.24 (95% CI 1.03&Acirc;&shy;1.49), respectively. 

Conclusions
We demonstrated a wide spreading of unrecognized hypertension in diabetic coronary patients; their 5-year mortality was significantly increased as compared with normotensives and tended to be even higher than in the diabetics previously identified as hypertensives. 

 

Tenenbaum A, Fisman EZ, Boyko V, et al. Unrecognized Hypertension in Diabetic Patients With Coronary Disease: Prevalence and Prognostic Significance. Eur Heart J. 1999;20:119, Abstr.730. 

  

Last Modified: 3/4/2013