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Resistant hypertension and risk of adverse events in individuals with type 1 diabetes: A nationwide prospective study

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posted on 04.06.2020 by Raija Lithovius, Valma Harjutsalo, Stefan Mutter, Daniel Gordin, Carol Forsblom, Per-Henrik Groop, FinnDiane Study Group
Objectives. To estimate the risk of diabetic nephropathy (DN) progression, incident coronary heart disease (CHD) and stroke, and all-cause mortality associated with resistant hypertension (RH) in individuals with type 1 diabetes stratified by stages of DN, renal function and sex.

Research Design and Methods This prospective study included a nationally representative cohort of individuals with type 1 diabetes from the Finnish Diabetic Nephropathy Study who had purchases of antihypertensive drugs at (±6 months) baseline visit (1995–2008). Individuals (N=1,103) were divided into three groups: (a) RH, (b) uncontrolled BP, but no RH and (c) controlled BP. DN progression, cardiovascular events and deaths were identified from the individuals’ healthcare records and national registries, until 31 December 2015.

Results At baseline 18.7% of the participants had RH, while 23.4% had controlled BP. After full adjustments for clinical confounders, RH was associated with increased risk of DN progression (HR 1.95 [95% CI 1.37, 2.79], p=0.0002), while no differences were observed in those with no RH (1.05 [0.76, 1.44], p=0.8), compared with those who had controlled BP. The risk of incident CHD, incident stroke and all-cause mortality was higher in individuals with RH compared with those who had controlled BP, but not beyond albuminuria and reduced kidney function. Notably, in those with normo- and microalbuminuria the risk of stroke remained higher in the RH compared to controlled BP group (3.49 [81.20, 10.15], p=0.02).


Conclusion Our findings highlight importance to identify and provide diagnostic and therapeutic counseling to these very high risk individuals with RH.

Funding

The study was supported by grants from Folkhälsan Research Foundation, Wilhelm and Else Stockmann Foundation, Academy of Finland (299200, 275614 and 316664), Liv och Hälsa Society, Novo Nordisk Foundation (NNFOC0013659), Medical Society of Finland (Finska Läkaresällskapet), Dorothea Olivia, Karl Walter and Jarl Walter Perklén Foundation, Päivikki and Sakari Sohlberg Foundation, Sigrid Juselius Foundation, Finnish Foundation for Cardiovascular Research, University of Helsinki (Clinical Researcher stint), and Helsinki University Hospital Research Funds (EVO).

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