Hypertensive diabetic patients: incidence of cardiovascular and renal outcomes in a historical cohort over 11 years

Andréa Cristina Sousa, Thiago Veiga Jardim, Thiago Olivera Costa, Fabrício Galdino Magalhães, Marcos Paulo Marinho Montelo, Weimar K. Barroso Souza, Paulo César Brandão Veiga Jardim, Ana Luiza Lima Sousa

Diabetics have increased risks for cardiovascular disease (CVD) and mortality, reducing their life expectancy by up to 15 years. Type 2 diabetes mellitus specifically increases the risk for cardiovascular mortality nearly fivefold. When hypertension is combined with diabetes, the risk of CVD is even greater. Identify non-fatal cardiovascular outcomes and renal function impairment in a cohort of hypertensive patients in regular treatment in a reference treatment center, over 11 years of follow-up. Historical cohort of hypertensive patients in regular treatment for at least 11 years in a specialized service for hypertension treatment. The exposed group was hypertensive diabetic patients at the beginning of the cohort, and the non-exposed group had hypertension without diabetes. The cohort began in 2004, with follow-ups in 2009 and 2015. Variables used: gender, race, age, physical activity, alcohol consumption, smoking, blood pressure, body mass index, glycated hemoglobin, diabetes and hypertension diagnosis times, treatment time in specialized service, non-fatal cardiovascular outcomes, and renal impairment assessed by creatinine clearance. 139 patients participated in the study (55 diabetic hypertensive; 84 non-diabetic hypertensive), with an initial (2004) mean hypertension treatment time of 5.8 years. Females were the majority (75.5%) in both groups. Groups were similar regarding socio-demographic variables, but the group of hypertensive diabetic patients had higher frequency of obesity and uncontrolled BP, which persisted in all follow-ups. In 11 years of follow-up (2004-2015), the diabetic group had more cardiovascular events, with increased risk of acute myocardial infarction (RR 95% CI 1.6 12.2-95.0), stroke (RR 95% CI 1.3-6.1 27.7) and complications requiring hospitalization (RR 95% CI 1.6 2.2-3.0). Worsened renal function occurred more often in the non-exposed group, but in the end, the proportion of renal function loss was similar between groups. Exposure to type 2 diabetes increased the risk of new cardiovascular outcomes over 11 years of follow-up of hypertensive patients. Diabetes by itself increased the risk of cardiovascular outcomes, justifying more intensive actions in this population.