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
Received 20 October 2018
Accepted for publication 21 May 2019
Published 15 July 2019 Volume 2019:12 Pages 1123—1139
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 2
Editor who approved publication: Professor Ming-Hui Zou
Moluk Hadi Alijanvand,1–3 Ashraf Aminorroaya,2 Iraj Kazemi,4 Sima Aminorroaya Yamini,5 Mohsen Janghorbani,1,2 Masoud Amini,2 Marjan Mansourian1,2
1Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran; 2Isfahan Endocrine and Metabolism Research Centre, Isfahan University of Medical Sciences, Isfahan, Iran; 3Student Research Center, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran; 4Department of Statistics, College of Science, University of Isfahan, Isfahan, Iran; 5Department of Engineering and Mathematics, Sheffiled Hallam University, Sheffield, UK
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
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