Contrasting mortality risks among subgroups of treated hypertensive patients developing new-onset diabetes

Eur Heart J. 2016 Mar 21;37(12):968-74. doi: 10.1093/eurheartj/ehv557. Epub 2015 Oct 27.


Aims: Hypertension and diabetes mellitus (DM) frequently cluster together and synergistically increase cardiovascular risk. Among those who develop DM during treatment for hypertension (new-onset diabetes, NOD), it is unclear whether NOD reflects a separate entity associated with increased risk or merely reflects accelerated presentation of DM.

Methods and results: We analysed data on 15 089 hypertensive patients attending the Glasgow Blood Pressure Clinic. The date at first hospital encounter either with diagnosis of diabetes or prescription of anti-hyperglycaemic medication were considered as the onset of diabetes. Cox proportional hazard models (including propensity score matching) were employed to study associations between diabetes status, early and late NOD (diagnosis <10 years or >10 years from first clinic visit) and cause-specific mortality. There were 2516 patients (16.7%) with DM, of whom 1862 (12.3%) had NOD [early NOD = 705 (4.6%); late NOD = 1157 (7.6%)]. The incidence rate of NOD was 8.2 per 1000 person-years. The total time at risk was 239 929 person-years [median survival: 28.1 years (inter-quartile range: 16.2-39.9)]. Compared with non-diabetic individuals, prevalent DM [hazard ratio (HR) = 1.8, 95% confidence interval (CI): 1.4-2.2] and time varying NOD status (HR: 1.09, 95% CI: 1.06-1.17) were associated with increased adjusted all-cause mortality. Early NOD (HR: 1.39, 95% CI: 1.2-1.6) was associated with increased in mortality risk, but not late NOD (HR: 0.92, 95% CI: 0.83-1.01). Results were consistent in the propensity score matched analyses.

Conclusion: Although 1-in-8 hypertensive patients develop NOD, mortality is increased only in the 1-in-20 who develop early NOD. Further studies are warranted to determine if early identification of such individuals should provide an alert for intensification of therapeutic interventions.

Keywords: Hypertension; Mortality; New-onset diabetes mellitus; Pre-diabetes.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age of Onset
  • Antihypertensive Agents / therapeutic use
  • Diabetic Angiopathies / drug therapy
  • Diabetic Angiopathies / mortality*
  • Female
  • Humans
  • Hypertension / drug therapy
  • Hypertension / mortality*
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Risk Factors
  • Scotland / epidemiology
  • Treatment Outcome


  • Antihypertensive Agents