The association between fasting plasma glucose and glycated hemoglobin in the prediabetes range and future development of hypertension
Abstract Background Prediabetes is a well-established risk factor for progression to overt diabetes mellitus (DM), which is in turn associated with development of hypertension (HTN) and vice versa. However, the role of prediabetes and HbA1c in particular as an independent risk factor for the develop...
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doaj-7abd5c7b35b84330acf1d4225c43679c2020-11-25T02:48:26ZengBMCCardiovascular Diabetology1475-28402019-04-011811910.1186/s12933-019-0859-4The association between fasting plasma glucose and glycated hemoglobin in the prediabetes range and future development of hypertensionMika Geva0Gadi Shlomai1Anat Berkovich2Elad Maor3Avshalom Leibowitz4Alexander Tenenbaum5Ehud Grossman6Department of Internal Medicine D, Chaim Sheba Medical CenterDepartment of Internal Medicine D, Chaim Sheba Medical CenterSackler School of Medicine, Tel-Aviv UniversitySackler School of Medicine, Tel-Aviv UniversityDepartment of Internal Medicine D, Chaim Sheba Medical CenterSackler School of Medicine, Tel-Aviv UniversityDepartment of Internal Medicine D, Chaim Sheba Medical CenterAbstract Background Prediabetes is a well-established risk factor for progression to overt diabetes mellitus (DM), which is in turn associated with development of hypertension (HTN) and vice versa. However, the role of prediabetes and HbA1c in particular as an independent risk factor for the development of hypertension is unclear. Aim In this current study, we aimed to evaluate the association between both fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) levels in the prediabetes range and development of HTN among a large cohort of normotensive subjects. Design and methods We investigated 5016 normotensive participants without DM and other cardiovascular risk factors who were annually screened in a tertiary medical center. Subjects were divided into normoglycemic and prediabetic groups. Normoglycemia was defined as HbA1c < 5.7% and FPG < 100 mg/dl. Prediabetes was defined according to the ADA criteria, i.e., 6.5% > HbA1c ≥ 5.7% or impaired fasting glucose (IFG):126 mg/dl > FPG ≥ 100 mg/dl. Subgroup analysis was made by dividing participants into four groups according to FPG and HbA1C levels, i.e., normoglycemia, impaired HbA1c only, IFG only, and both parameters impaired. Results During a follow-up of 3.7 ± 2.9 years, 318 (6.3%) subjects developed HTN. A cumulative hazard function for the development of hypertension showed a 2.89-fold ([95% CI 2.19–3.83], p < .0001) increased risk for HTN in the prediabetic population. In a multivariable Cox proportional hazard regression model adjusted to common confounding risk factors for HTN, prediabetes was found to be independently associated with a 1.95-fold ([95%, CI 1.43–2.52] p < .0001) increased risk for hypertension. Impaired HbA1C only was not found to be independently associated with HTN, while IFG only showed a 2.13-fold (95%, [CI 1.46–3.11] p < .0001) increased risk for HTN compared to normoglycemic, and a 2.55-fold ([95% CI 1.85–3.51] p < .0001) increased risk for HTN when both parameters impaired. Conclusion Our study demonstrates that FPG in the prediabetes range, albeit not glycated hemoglobin, is independently and significantly associated with future development of HTN. Therefore, our findings further highlight the pivotal predictive role of IFG for HTN development as opposed to the limited independent role of abnormal HbA1c levels.http://link.springer.com/article/10.1186/s12933-019-0859-4PrediabetesHbA1cImpaired fasting glucoseHypertensionInsulin resistanceCardiovascular risk |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Mika Geva Gadi Shlomai Anat Berkovich Elad Maor Avshalom Leibowitz Alexander Tenenbaum Ehud Grossman |
spellingShingle |
Mika Geva Gadi Shlomai Anat Berkovich Elad Maor Avshalom Leibowitz Alexander Tenenbaum Ehud Grossman The association between fasting plasma glucose and glycated hemoglobin in the prediabetes range and future development of hypertension Cardiovascular Diabetology Prediabetes HbA1c Impaired fasting glucose Hypertension Insulin resistance Cardiovascular risk |
author_facet |
Mika Geva Gadi Shlomai Anat Berkovich Elad Maor Avshalom Leibowitz Alexander Tenenbaum Ehud Grossman |
author_sort |
Mika Geva |
title |
The association between fasting plasma glucose and glycated hemoglobin in the prediabetes range and future development of hypertension |
title_short |
The association between fasting plasma glucose and glycated hemoglobin in the prediabetes range and future development of hypertension |
title_full |
The association between fasting plasma glucose and glycated hemoglobin in the prediabetes range and future development of hypertension |
title_fullStr |
The association between fasting plasma glucose and glycated hemoglobin in the prediabetes range and future development of hypertension |
title_full_unstemmed |
The association between fasting plasma glucose and glycated hemoglobin in the prediabetes range and future development of hypertension |
title_sort |
association between fasting plasma glucose and glycated hemoglobin in the prediabetes range and future development of hypertension |
publisher |
BMC |
series |
Cardiovascular Diabetology |
issn |
1475-2840 |
publishDate |
2019-04-01 |
description |
Abstract Background Prediabetes is a well-established risk factor for progression to overt diabetes mellitus (DM), which is in turn associated with development of hypertension (HTN) and vice versa. However, the role of prediabetes and HbA1c in particular as an independent risk factor for the development of hypertension is unclear. Aim In this current study, we aimed to evaluate the association between both fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) levels in the prediabetes range and development of HTN among a large cohort of normotensive subjects. Design and methods We investigated 5016 normotensive participants without DM and other cardiovascular risk factors who were annually screened in a tertiary medical center. Subjects were divided into normoglycemic and prediabetic groups. Normoglycemia was defined as HbA1c < 5.7% and FPG < 100 mg/dl. Prediabetes was defined according to the ADA criteria, i.e., 6.5% > HbA1c ≥ 5.7% or impaired fasting glucose (IFG):126 mg/dl > FPG ≥ 100 mg/dl. Subgroup analysis was made by dividing participants into four groups according to FPG and HbA1C levels, i.e., normoglycemia, impaired HbA1c only, IFG only, and both parameters impaired. Results During a follow-up of 3.7 ± 2.9 years, 318 (6.3%) subjects developed HTN. A cumulative hazard function for the development of hypertension showed a 2.89-fold ([95% CI 2.19–3.83], p < .0001) increased risk for HTN in the prediabetic population. In a multivariable Cox proportional hazard regression model adjusted to common confounding risk factors for HTN, prediabetes was found to be independently associated with a 1.95-fold ([95%, CI 1.43–2.52] p < .0001) increased risk for hypertension. Impaired HbA1C only was not found to be independently associated with HTN, while IFG only showed a 2.13-fold (95%, [CI 1.46–3.11] p < .0001) increased risk for HTN compared to normoglycemic, and a 2.55-fold ([95% CI 1.85–3.51] p < .0001) increased risk for HTN when both parameters impaired. Conclusion Our study demonstrates that FPG in the prediabetes range, albeit not glycated hemoglobin, is independently and significantly associated with future development of HTN. Therefore, our findings further highlight the pivotal predictive role of IFG for HTN development as opposed to the limited independent role of abnormal HbA1c levels. |
topic |
Prediabetes HbA1c Impaired fasting glucose Hypertension Insulin resistance Cardiovascular risk |
url |
http://link.springer.com/article/10.1186/s12933-019-0859-4 |
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