Does intensive BP lowering increase the risk for diabetes?

  • Roumie CL & al.
  • Hypertension
  • 23 Dec 2019

  • International Clinical Digest
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Takeaway

  • Intensive BP treatment in the Systolic Blood Pressure Intervention Trial (SPRINT) was associated with a nonsignificantly increased risk for incident diabetes and significantly increased risk for impaired fasting glucose (IFG).

Why this matters

  • Role of hypertension control in diabetes is complex.

Study design

  • Evaluation of diabetes incidence in SPRINT, in which participants with baseline systolic BP (SBP) 130-180 mmHg were randomly allocated to intensive (SBP
  • Funding: NIH; study medications from Takeda Pharmaceuticals International, Inc.

Key results

  • Diabetes events (reaching fasting blood glucose ≥126 mg/dL [≥6.99 mmol/L], self-report of diabetes at annual examination, new use of hypoglycemic medications):
    • Intensive: 299.
    • Standard: 251.
  • After adjustments for baseline covariates, adjusted (a)HR was 1.17 (95% CI, 0.99-1.39).
  • Elevated fasting glucose event rates:
    • Intensive: 12.7 per 1000 person-years.
    • Standard: 10.4 per 1000 person-years.
    • aHR, 1.19 (95% CI, 0.95-1.49).
  • New diabetes self-report rates:
    • Intensive: 11.9 per 1000 person-years.
    • Standard: 8.8 per 1000 person-years.
    • aHR, 1.33 (P=.02).
  • IFG incidence rates with normal baseline blood glucose:
    • Intensive (n=2752): 26.4 per 100 person-years.
    • Standard (n=2746): 22.5 per 100 person-years.
    • aHR, 1.17 (P=.002).

Limitations

  • Possible self-reporting bias.
  • Underpowered.
  • Short follow-up duration.