Cross-sectional and longitudinal assessments of risk factors associated with hypertension and moderately increased albuminuria comorbidity in patients with type 2 diabetes: a 9-year open cohort study

Abstract

Background

Moderately increased albuminuria (MIA) is strongly associated with hypertension (HTN) in patients with type 2 diabetic mellitus (T2DM). However, the association between risk factors and coexisting HTN and MIA remains unassessed.

Objectives

This study aimed to determine both cross-sectional and longitudinal associations of risk factors with HTN and MIA comorbidity in patients with T2DM.

Methods

A total of 1,600 patients with T2DM were examined at baseline and longitudinal data were obtained from 1,337 T2DM patients with at least 2 follow-up visits to assess the presence of HTN alone (yes/no), MIA alone (yes/no) and the coexistence of both (yes/no) in a 9-year open cohort study between 2004 and 2013. Bivariate mixed-effects logistic regression with a Bayesian approach was employed to evaluate associations of risk factors with HTN and MIA‎ comorbidity in the longitudinal assessment.

Results

After adjustment for age and BMI, patients with uncontrolled plasma glucose, as a combined index of the glucose profile, were more likely to have HTN [odds ratio (OR): 1.73 with 95% Bayesian credible intervals (BCI) 1.29–2.20] and MIA [OR: 1.34 (‎95% BCI 1.13–1.62)]. The risks of having HTN and MIA were increased by a one-year raise in diabetes duration [with 0.89 (95% BCI 0.84–0.96) and 0.81 (95% BCI 0.73–0.92) ORs, respectively] and a one-unit increase in non-high-density lipoprotein-cholesterol (Non-HDL-C) [with 1.30 (95% BCI 1.23–1.34) and 1.24 (95% BCI 1.14–1.33) ORs, respectively].

Conclusions

T2DM patients with HTN,‎ MIA, and the coexistence of both had uncontrolled plasma glucose, significantly higher Non-HDL-C, and shorter diabetes duration than the other T2DM patients. Duration of diabetes and uncontrolled plasma glucose index showed the stronger effects on HTN and MIA comorbidity than on each condition separately.

Keywords:

• hypertension
• moderately increased albuminuria
• microalbuminuria
• type 2 diabetes
• comorbidity
• risk factor

Acknowledgments

The authors would like to thank all participants. We are thankful to Mrs Maryam Zare and Mr Majid Abyar who assisted authors in using the recorded data of Isfahan Endocrine and Metabolism Research Center. We would also like to thank the Student Research Center, School of Health, Endocrine and Metabolism Research Centre, Isfahan University of Medical Sciences, Isfahan, Iran. This research was funded by the Student Research Center, School of Health, Endocrine and Metabolism Research Centre, Isfahan University of Medical Sciences, Isfahan, Iran (No. 394909).

Ethics approval and informed consent

The present study conforms to the principles outlined in the Declaration of Helsinki. The protocol of the IDOPS was also approved by the Ethics Committee of the Isfahan University of Medical Sciences (IUMS) and Research Ethics Committee of Isfahan Endocrine and Metabolism Research Center (IEMRC) (No. 394909). Informed consent was obtained from all individual participants included in the study.

Data availability

The data used to support the findings of the present study are available from the corresponding authors upon request.

Supplementary materials

Table S1 Correlation between fasting plasma glucose, 2 hrs postprandial plasma glucose, and glycosylated hemoglobin at baseline

Table S2 Baseline characteristics in T2DM patients with or without follow-up

Table S3 Results of multiple pairwise comparisons between the groups at baseline

Table S4 Result of Bayesian univariate and bivariate logistic regression with random subject effect, with and without considering moderately increased albuminuria and hypertension comorbidity

Table S5 Result of Bayesian univariate and bivariate logistic regression with random subject effect, with and without considering moderately increased albuminuria and hypertension comorbidity

Figure S1 Age and body mass index-adjusted means of lipid and glucose profiles in different groups of type 2 diabetic patients. (A) Age and body mass index-adjusted means of glucose profile in different groups of type 2 diabetic patients. (B) Age and body mass index-adjusted means of lipid profile in different groups of type 2 diabetic patients.

Note: ^acontrol group.
Abbreviations: MIA, moderately increased albuminuria; HTN, hypertension; FPG, fasting plasma glucose; PPG, postprandial plasma glucose; HbA1C, glycosylated hemoglobin; Total-Chol, total cholesterol; Non-HDL-Chol, non-high-density lipoprotein cholesterol; LDL-Chol, low density lipoprotein cholesterol.

Author contributions

All authors contributed toward data analysis, drafting and critically revising the paper, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in regard to this work.