Prevalence of hypertension in Type 1 (insulin-dependent) diabetes mellitus (original) (raw)

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The prevalence of hypertension in a representative sample (_n_=10202) of the Danish general population aged 16–59 years was assessed to 4.4% based on three blood pressure readings. In Type 1 (insulin-dependent) diabetic patients of similar age (_n_=1703) the prevalence was determined in a similar way to 14.7% (p<0.00001). The excess prevalence in Type 1 diabetic patients was due to hypertension in patients with incipient and clinical nephropathy as the prevalence of hypertension among diabetic patients with normal urinary albumin excretion (essential hypertension) was 3.9%, similar to that observed in the general population. The patients with Type 1 diabetes and essential hypertension had higher systolic (146±19 vs 133±18 mmHg, p<0.00001) and diastolic blood pressure (87±12 vs 79±7mmHg, p<0.00001), but less changes in the eye background than patients with incipient nephropathy (urinary albumin excretion 30–300 mg/24 h) (p<0.03), indicating that the two groups were also different with respect to other microangiopathic lesions. Patients with essential hypertension were defined as having a normal urinary albumin excretion before and during antihypertensive treatment (if any). They were followed-up for a 58 (6–234) month period. We confirmed that hypertension is more common among Type 1 diabetic patients than in the general population and found the prevalence of essential hypertension similar in Type 1 diabetic patients to the non-diabetic population. This supports our hypothesis that hypertension is very unlikely to be the cause of diabetic nephropathy.

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References

  1. Major SG (1929) Blood pressure in diabetes mellitus: a statistical study. Arch Intern Med 44: 797–812
    Google Scholar
  2. Adams S (1929) A study of the blood pressure of patients with diabetes mellitus. Am J Med Soc 177: 195–201
    Google Scholar
  3. Pell S, D'Alonzo CA (1967) Some aspects of hypertension in diabetes mellitus. JAMA 202: 104–110
    Google Scholar
  4. Christlieb AR, Warram JH, Krolewski AS, Busick EJ, Ganda OP, Asmal AC, Soeldner JS, Bradley RF (1981) Hypertension: the major risk factor in juvenile-onset insulin-dependent diabetics. Diabetes 30 [Suppl 2]: 90–96
    Google Scholar
  5. Kelleher C, Kingston SM, Barry DG, Cole MM, Ferris JB, Grealy G, Joyce C, O'Sullivann DJ (1988) Hypertension in diabetic clinic patients and their siblings. Diabetologia 31: 76–81
    Google Scholar
  6. Simonsen DC (1988) Etiology and prevalence of hypertension in diabetic patients. Diabetes Care 11: 821–827
    Google Scholar
  7. Sprafka JM, Bender AP, Jagger HG (1988) Prevalence of hypertension and associated risk factors among diabetic individuals. The Three-City study. Diabetes Care 11: 17–22
    Google Scholar
  8. Parving HH, Andersen AR, Schmidt UM, Svendsen PA (1983) Early aggresive antihypertensive treatment reduces rate of decline in kidney function in diabetic nephropathy. Lancet I: 1175–1179
    Google Scholar
  9. Mogensen CE (1982) Long-term antihypertensive treatment inhibiting progression of diabetic nephropathy. Br Med J 285: 685–688
    Google Scholar
  10. Mathiesen ER, Rønn B, Jensen T, Storm B and Deckert T (1988) Microalbuminuria precedes elevation in blood pressure in diabetic nephropathy. Diabetologia 31: 519 (Abstract)
    Google Scholar
  11. Deckert T, Feldt-Rasmussen B, Borch-Johnsen K, Jensen T, Kofoed-Enevoldsen A (1989) Albuminuria reflects widespread vascular damage. The Steno hypothesis. Diabetologia 32: 219–226
    Google Scholar
  12. Kofoed-Enevoldsen A, Borch-Johnsen K, Kreiner S, Deckert T (1987) Declining incidence of persistent proteinuria in Type 1 (insulin-dependent) diabetic patients in Denmark. Diabetes 36: 205–209
    Google Scholar
  13. Feldt-Rasmussen B, Dinesen B, Deckert M (1985) Enzyme immunoassay-an improved determination of urinary albumin in diabetics with incipient nephropathy. Scand J Clin Lab Invest 45: 539–544
    Google Scholar
  14. Sælan H, Krasnik A, Kempinski R (1979) Community medicine in the primary health sector. II. The distribution of blood-pressure as a risk factor, a community diagnosis. Ugeskr Læg 141: 45–51
    Google Scholar
  15. Marre M, Leblanc H, Suarez L, Guyenne T-T, Menard J, Passa P (1987) Converting enzyme inhibition and kidney function in normotensive diabetic patients with persistent microalbuminuria. Br Med J 294: 1448–1452
    Google Scholar
  16. Christensen CK, Mogensen CE (1987) Antihypertensive treatment: long-term reversal of progression of albuminuria in incipient diabetic nephropathy. A longitudinal study of renal function. J Diab Compl 1: 45–52
    Google Scholar
  17. Parving H-H, Gyntelberg F (1973) Transcapillary escape rate of albumin and plasma volume in essential hypertension. Cir Res 32: 643–651
    Google Scholar
  18. Christensen CK, Krusell, Mogensen CE (1987) Increased blood pressure in diabetes: essential hypertension or diabetic nephropathy? Scand J Clin Lab Invest 47: 363–370
    Google Scholar
  19. Gordon T, Shurtleff D (1974) Means at each examination and interexamination variation of specified characteristics: Framingham Study Exam 1 to 10. NIH Publication no. 74–478
  20. Parving H-H, Hommel E, Mathiesen E, Skøtt P, Edsberg B, Bahnsen M, Lauritzen M, Hougaard P, Lauritzen E (1988) Prevalence of microalbuminuria, arterial hypertension, retinopathy and neuropathy in patients with insulin dependent diabetes. Br Med J 296: 156–160
    Google Scholar

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Authors and Affiliations

  1. Steno Memorial Hospital, Gentofte, University of Copenhagen, Denmark
    K. Nørgaard, B. Feldt-Rasmussen, K. Borch-Johnsen & T. Deckert
  2. Institute for Social Medicine, University of Copenhagen, Denmark
    H. Sælan

Authors

  1. K. Nørgaard
  2. B. Feldt-Rasmussen
  3. K. Borch-Johnsen
  4. H. Sælan
  5. T. Deckert

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Nørgaard, K., Feldt-Rasmussen, B., Borch-Johnsen, K. et al. Prevalence of hypertension in Type 1 (insulin-dependent) diabetes mellitus.Diabetologia 33, 407–410 (1990). https://doi.org/10.1007/BF00404089

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