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

BACKGROUND: 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...

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Autores principales: Sousa, Andréa Cristina, Jardim, Thiago Veiga, Costa, Thiago Olivera, Magalhães, Fabrício Galdino, Montelo, Marcos Paulo Marinho, Souza, Weimar K. Barroso, Jardim, Paulo César Brandão Veiga, Sousa, Ana Luiza Lima
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5738831/
https://www.ncbi.nlm.nih.gov/pubmed/29296123
http://dx.doi.org/10.1186/s13098-017-0296-z
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author Sousa, Andréa Cristina
Jardim, Thiago Veiga
Costa, Thiago Olivera
Magalhães, Fabrício Galdino
Montelo, Marcos Paulo Marinho
Souza, Weimar K. Barroso
Jardim, Paulo César Brandão Veiga
Sousa, Ana Luiza Lima
author_facet Sousa, Andréa Cristina
Jardim, Thiago Veiga
Costa, Thiago Olivera
Magalhães, Fabrício Galdino
Montelo, Marcos Paulo Marinho
Souza, Weimar K. Barroso
Jardim, Paulo César Brandão Veiga
Sousa, Ana Luiza Lima
author_sort Sousa, Andréa Cristina
collection PubMed
description BACKGROUND: 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. OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
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spelling pubmed-57388312018-01-02 Hypertensive diabetic patients: incidence of cardiovascular and renal outcomes in a historical cohort over 11 years Sousa, Andréa Cristina Jardim, Thiago Veiga Costa, Thiago Olivera Magalhães, Fabrício Galdino Montelo, Marcos Paulo Marinho Souza, Weimar K. Barroso Jardim, Paulo César Brandão Veiga Sousa, Ana Luiza Lima Diabetol Metab Syndr Research BACKGROUND: 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. OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. BioMed Central 2017-12-21 /pmc/articles/PMC5738831/ /pubmed/29296123 http://dx.doi.org/10.1186/s13098-017-0296-z Text en © The Author(s) 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Sousa, Andréa Cristina
Jardim, Thiago Veiga
Costa, Thiago Olivera
Magalhães, Fabrício Galdino
Montelo, Marcos Paulo Marinho
Souza, Weimar K. Barroso
Jardim, Paulo César Brandão Veiga
Sousa, Ana Luiza Lima
Hypertensive diabetic patients: incidence of cardiovascular and renal outcomes in a historical cohort over 11 years
title Hypertensive diabetic patients: incidence of cardiovascular and renal outcomes in a historical cohort over 11 years
title_full Hypertensive diabetic patients: incidence of cardiovascular and renal outcomes in a historical cohort over 11 years
title_fullStr Hypertensive diabetic patients: incidence of cardiovascular and renal outcomes in a historical cohort over 11 years
title_full_unstemmed Hypertensive diabetic patients: incidence of cardiovascular and renal outcomes in a historical cohort over 11 years
title_short Hypertensive diabetic patients: incidence of cardiovascular and renal outcomes in a historical cohort over 11 years
title_sort hypertensive diabetic patients: incidence of cardiovascular and renal outcomes in a historical cohort over 11 years
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5738831/
https://www.ncbi.nlm.nih.gov/pubmed/29296123
http://dx.doi.org/10.1186/s13098-017-0296-z
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