Different Combinations of Glucose Tolerance and Blood Pressure Status and Incident Diabetes,Hypertension,and Chronic Kidney Disease

Background: the impact of different combinations of glucose tolerance and blood pressure status on the development of type 2 diabetes mellitus (t2dm),hypertension (htn),and chronic kidney disease (ckd) still needs to be investigated. methods and results: a total of 12 808 iranian adults aged ≥20 years were included in 3 separate analyses to investigate incidence of t2dm,htn,and ckd. multivariate cox proportional hazard models were used to calculate hazard ratios (95% ci). during a median follow-up of >10 years,the overall incidence rate for t2dm,htn,and ckd was 12.2,29.8,and 24.8 per 1000 person-years. for incident t2dm,considering normal glucose tolerance/normal blood pressure as reference,prediabetes (predm)/htn had the highest risk (hazard ratio: 7.22 [5.71-9.12]) while predm/normal blood pressure also showed a significant risk (5.58 [4.41-7.05]). furthermore,risk of predm/htn was higher than predm/normal blood pressure (p<0.05). for incident htn,normal glucose tolerance/prehypertension was a strong predictor (3.28 [2.91-3.69]); however,addition of predm or t2dm did not increase the risk. for incident ckd,every category that included htn and/or t2dm showed significant risk; this risk was marginally significant for the predm/htn group (1.19 [0.98-1.43],p=0.06). in addition,predm/ normal blood pressure was a marginally significant risk factor for incident htn while normal glucose tolerance/prehypertension was a significant predictor of t2dm. conclusions: presence of htn was associated with increased risk of t2dm among the predm population; however,dysglycemia did not increase the risk of htn among individuals with prehypertension. for incident ckd,intensive management of htn and t2dm,rather than their predisease states,should be considered. © 2016 the authors. published on behalf of the american heart association,inc.,by wiley blackwell.