Abstract 14560: Diabetes Mellitus and Hypertension Subtypes in Relation to Cardiovascular and All-Cause Mortality

Background: Diabetes mellitus (DM) is associated with increased arterial stiffness indicated by isolated systolic hypertension (ISH). Whether this relates to greater cardiovascular disease (CVD) mortality remains unclear. We compare by DM status the association of hypertension subtypes with CVD and all-cause mortality.

Methods: We included data from the National Health and Nutrition Examination Survey 1999-2008 with mortality follow-up until 2018. We used systolic and diastolic blood pressure cut points of 130 and 80 mmHg to define ISH, isolated diastolic hypertension (IDH), and systolic diastolic hypertension (SDH) with DM based on self-report, glucose ≥126 mg/dL if fasting or ≥200 mg/dL if non-fasting, use of DM medications or insulin, or HbA1c≥6.5%. The incidence of CVD and all-cause mortality was examined among hypertensive subtypes (vs. normotension) using Cox regression, adjusting for age, ethnicity, gender, tobacco use, dyslipidemia, and use of antihypertensive agents.

Results: 23,198 individuals (projected to 194 million) were included of which 14% had DM (projected to 19 million). In those with vs. without DM, 40% vs. 60% were normotensive, 5% vs. 9% had IDH, 39% vs. 18% had ISH, and 16% vs. 13% had SDH (p<0.001). Adjusted analyses showed increased risk of CVD and all-cause mortality with ISH and IDH in patients with and without DM. IDH was significantly associated with increased CVD and all-cause mortality in individuals with DM but not in individuals without DM (p<0.0001 for interaction comparing the relation of subtypes with mortality endpoints by DM status).

Conclusions: All hypertension subtypes were significantly associated with increased CVD and all-cause mortality in patients with DM, whereas in patients without DM only ISH and SDH carried increased mortality risk. The strength of association was also significantly greater in patients with DM.