Objective: To examine sex-specific associations between blood pressure levels and incident type 2 diabetes mellitus in a representative population sample in Germany.
Methods: The study was based on 5556 men and 5445 women (aged 25-74 years) who participated in one of the three Monitoring Trends and Determinants on Cardiovascular Diseases Augsburg surveys between 1984 and 1995 and who were free of diabetes at baseline. Sex-specific hazard ratios were estimated from Cox proportional hazard models.
Results: A total of 410 cases of incident type 2 diabetes among men and 263 among women were registered during the median follow-up period of 12.5 years. Higher blood pressure levels were associated with older age, higher body mass index (BMI), a higher prevalence of dyslipidemia, a lower prevalence of regular smoking, high alcohol consumption (men only), and a lower education level. Compared with individuals with normal blood pressure, the hazard ratios (95% confidence interval) of incident diabetes associated with an optimal blood pressure, high normal blood pressure, and hypertension were 0.67 (0.36-1.27), 1.76 (1.24-2.51), and 1.93 (1.41-2.65) for men and 0.74 (0.41-1.32), 1.07 (0.67-1.73), and 2.05 (1.41-2.99) for women. The found association was present in the subgroup with low BMI as well as in the group with high BMI supporting the assumption that blood pressure may contribute to the manifestation of type 2 diabetes independent of BMI.
Conclusion: Established hypertension was significantly associated with incident type 2 diabetes in men and women from the general population, whereas high normal blood pressure significantly increased the risk of diabetes in men only.