New diabetes has little impact on outcomes in elderly hypertensives

Nov 25 2013

By Eleanor McDermid, Senior medwireNews Reporter

Established, but not newly diagnosed, diabetes is associated with reduced survival among elderly patients with hypertension, shows an analysis of the ANBP2 study.

The finding is in line with some previous research, but other studies have shown an effect of newly diagnosed diabetes on outcomes.

The authors of the current study, Christopher Reid (Monash University, Melbourne, Australia) and co-workers, say that varying lengths of follow-up could help to explain the discrepancy. But they believe that for the patients in their study, who were aged at least 65 years at enrollment, newly diagnosed diabetes had a minimal impact over that of other comorbidities, such as cancer and dementia, that are often present in this age group.

Follow-up of the 6083 patients in the clinical trial phase of the ANBP2 (Second Australian National Blood Pressure) study lasted a median of 4.1 years. Survival of most of these patients was tracked post-trial using a national death registry for a median of 6.9 years.

By the end of the post-trial follow-up, diabetes had lasted a median of 15.4 years in the 7.2% of patients who had the condition at study entry, whereas it had lasted a median of 8.8 years in the 5.6% who had diabetes diagnosed during the clinical trial.

During the clinical and post-trial phases combined, 43.3% of patients with pre-existing diabetes died of any cause, as did 29.4% of those without diabetes, equating to a significant 50% increased risk in the former group. By contrast, the all-cause mortality rate among patients with newly diagnosed diabetes was identical to that in patients who remained free of the condition.

There was a similar pattern for cardiovascular mortality, with rates of 19.7% versus 13.0% among patients with established and no diabetes, respectively, and of 10.0% among those with newly diagnosed diabetes.

“These findings from a community-based clinical setting may have implications for clinicians making decisions about the choice of antihypertensive therapy in older patients at risk of developing diabetes,” write Reid et al in the American Journal of Hypertension.

They observe that some antihypertensive agents are believed to add to the risk for diabetes in patients already at risk, so physicians can counteract this through careful selection of medication.

“Consideration of the individual patient’s risk factors for diabetes is important in the choice of therapies for chronic diseases such as hypertension,” says the team.

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