uu.seUppsala University Publications
Change search
ReferencesLink to record
Permanent link

Direct link
Are blood pressure and diabetes additive or synergistic risk factors?: outcome in 8494 subjects randomly recruited from 10 populations
Show others and affiliations
2011 (English)In: Hypertension Research, ISSN 0916-9636, Vol. 34, no 6, 714-721 p.Article in journal (Refereed) Published
Abstract [en]

It remains unknown whether diabetes and high blood pressure (BP) are simply additive risk factors for cardiovascular outcome or whether they act synergistically and potentiate one another. We performed 24-h ambulatory BP monitoring in 8494 subjects (mean age, 54.6 years; 47.0% women; 6.9% diabetic patients) enrolled in prospective population studies in 10 countries. In multivariable-adjusted Cox regression, we assessed the additive as opposed to the synergistic effects of BP and diabetes in relation to a composite cardiovascular endpoint by testing the significance of appropriate interaction terms. During 10.6 years (median follow-up), 1066 participants had a cardiovascular complication. Diabetes mellitus as well as the 24-h ambulatory BP were independent and powerful predictors of the composite cardiovascular endpoint. However, there was no synergistic interaction between diabetes and 24-h, daytime, or nighttime, systolic or diastolic ambulatory BP (P for interaction, 0.07 <= P <= 0.97). The only exception was a borderline synergistic effect between diabetes and daytime diastolic BP in relation to the composite cardiovascular endpoint (P=0.04). In diabetic patients, with normotension as the reference group, the adjusted hazard ratios for the cardiovascular endpoint were 1.35 (95% confidence interval (CI), 0.87-2.11) for white-coat hypertension, 1.78 (95% CI, 1.22-2.60) for masked hypertension and 2.44 (95% CI, 1.92-3.11) for sustained hypertension. The hazard ratios for non-diabetic subjects were not different from those of diabetic patients (P-values for interaction, 0.09 <= P <= 0.72). In conclusion, in a large international population-based database, both diabetes mellitus and BP contributed equally to the risk of cardiovascular complications without evidence for a synergistic effect. Hypertension Research (2011) 34, 714-721; doi:10.1038/hr.2011.6; published online 10 February 2011

Place, publisher, year, edition, pages
2011. Vol. 34, no 6, 714-721 p.
Keyword [en]
ambulatory blood pressure, cardiovascular risk factors, diabetes mellitus, epidemiology, population science
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-155249DOI: 10.1038/hr.2011.6ISI: 000291302000008OAI: oai:DiVA.org:uu-155249DiVA: diva2:425255
Available from: 2011-06-21 Created: 2011-06-20 Last updated: 2011-06-21Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full text
By organisation
GeriatricsDepartment of Medical Sciences
In the same journal
Hypertension Research
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 162 hits
ReferencesLink to record
Permanent link

Direct link