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