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Blood Pressure and Risk for Developing Diabetes
Elevated BP as well as BP escalations over time — even if only in the high-normal range — puts women at increased risk for diabetes.


Hypertension, obesity, and diabetes often occur together, but the relation between blood pressure and diabetes is not well defined. Researchers for the Women’s Health Study analyzed data from more than 38,000 women (health professionals older than 45) to determine whether baseline BP and BP progression were associated independently with the development of type 2 diabetes. Women self-reported BP at baseline and every 6 months and were asked annually whether they had diagnosed diabetes (all cases were validated with medical record review). BP was classified as optimal (<120/75 mm Hg); normal (120–129/75–84 mm Hg); hig h normal (130–139/85–89 mm Hg); or established hypertension (self-reported, taking antihypertensive medication, or BP 140/90 mm Hg).

During a median 10-year follow-up, 9.4% of women in the baseline hypertensive category versus 1.4% of women in the optimal BP category developed type 2 diabetes. In analysis adjusted for factors such as age, ethnicity, and BMI, likelihood of developing type 2 diabetes was increased in women who were hypertensive (hazard ratio, 2.03; 95% confidence interval, 1.77–2.32) or had high-normal BP at baseline (HR, 1.45; 95% CI, 1.23–1.71), but not in women with optimal BP (HR, 0.66; 95% CI, 0.55–0.80) compared with those who had normal BP (reference group; P for trend, <0.0001). Similar risk patterns were noted for women whose BP progressed during follow-up. In analysis stratified by BMI, BP was still a strong predictor of incident diabetes. For example, diabetes risk in obese hypertensive women was nearly threefold that in obese women with optimal BP.

Comment: The results of this large observational study show that elevated BP as well as BP escalation over time — even if only in the high-normal range — is associated with increased risk for developing diabetes. Although the findings also suggest that the association between BP and incident diabetes is not explained by obesity, the possibility cannot be ruled out. We know that BP must be monitored carefully, but we have not established whether high-normal BP demands drug treatment. Clearly, life habits such as increasing physical activity, achieving optimal weight, and eating a healthy diet that limits sodium intake should be promoted strongly.

— Marian C. Limacher, MD

Published in Journal Watch Women's Health February 14, 2008