Issue 151 Item 15 Blood Pressure Rises Decades Before Diabetes Develops

Elevations in blood pressure precede the development of type 2 diabetes in middle age by 20 to 25 years. Higher blood pressure in the pre-diabetic state might contribute to the presence of vascular disease when the diabetes is diagnosed, say specialists at Johns Hopkins University School of Medicine, Baltimore, Maryland.

Although hypertension was known to accompany type 2 diabetes in middle age, the specialists pointed out that it had not been known how early in life it began to rise in people who later developed diabetes.

To evaluate elevated blood pressure as a long-term predictor of type 2 diabetes, the specialists assessed systolic and diastolic blood pressure from young adulthood to middle age in a prospective cohort study of 1,152 white male medical students in The Johns Hopkins Precursors Study.

Incident diabetes was identified by self-reporting in mailed questionnaires verified by medical record reviews. During a median follow-up of 38 years, 77 cases of incident diabetes occurred. The mean age of diabetes diagnosis was 58 years.

As early as age 30 years, mean systolic and diastolic blood pressures were significantly higher in men who developed diabetes during follow-up than in those who remained non-diabetic.

The rate of increase in systolic and diastolic blood pressures over time in men who developed diabetes was greater than it was in men who did not develop diabetes.

After adjustment for body mass index and other risk factors for diabetes, systolic and diastolic blood pressures at age 30 years remained significantly higher in men who developed diabetes than in those who did not. Diabetes Care 2003;26:4:1110-1115.