Does intensive BP lowering increase the risk for diabetes?

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 <120 mmHg; n=4187) vs standard (<140 mmHg; n=4193) BP lowering, with follow-up to about 3 years.  
• 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.