Hypertension Highly Prevalent Among Older Adults with Diabetes Mellitus

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Elderly patients with diabetes mellitus are at an increased risk developing hypertension compared to those without—though the correlation may be sex-specific.

In new data presented at the National Kidney Foundation 2024 Spring Clinical Meeting (SCM) in Long Beach, CA, this week, a multinational team of investigators reported an approximate 30% increased risk of developing hypertension among elderly persons who also had diabetes mellitus. The findings also suggested the association was significantly greater in men—potentially due to differences in sex hormones from women.¹

Investigators led by Ekamol Tantisattamo, MD, a nephrologist with University of California Irvine School of Medicine, sought to interpret the association between diabetes mellitus status and risk of developing hypertension in the elderly.

“Hypertension is a common comorbid disease in patients with diabetes mellitus,” the team wrote. “However, the association between diabetes mellitus and the onset of developing hypertension in the elderly is unknown.”

Though arterial stiffness is the understood key mechanism of progression to hypertension among elderly patients, there remains a need for further extrapolation as to how the condition is a risk factor for which aging patients. National examination-based survey data estimates 7 in every 10 adults aged ≥65 years old have hypertension; the same age group is expected to increase by about 40% by 2060.²

Tantisattamo and colleagues conducted their retrospective cohort analysis using data on self-reported diagnoses of diabetes mellitus and hypertension from the National Health and Nutrition Examination Survey (NHANES) from 2017 – 2020. They conducted a multiple Cox regression analysis to examine associations between status of diabetes mellitus and age of hypertension diagnosis.¹

Their final assessment included 2411 participants who were ≥65 years old at the time of the examination. Mean patient age was 73.5 years old; 50% were female. Investigators observed that 29% of patients were diagnosed with diabetes mellitus, while 95% were diagnosed with hypertension—the latter being an incident rate of once every 0.009 person-years. Median age of hypertension diagnosis was 57 years old.

The team reported that patients who developed hypertension had an earliest mean onset of diabetes mellitus than those without hypertension (57.0 vs 62.5 years old). Mean systolic and diastolic blood pressure (SBP; DBP) levels were 136±21 and 72±12 mmHg, respectively.

In non-adjusted analysis, investigators observed an insignificantly increased proportion of hypertension development among older patients without diabetes mellitus than in those with diabetes (95% vs 94%; P = .507). The team additionally observed insignificant differences in mean SBP levels in patients without and with diabetes mellitus (136±21 vs 135±22; P = .824). However, mean DBP was significantly higher among patients without diabetes mellitus than those with (73±12 vs 71±12; P = .0006).

Older patients with diabetes mellitus had a 24% increased risk of developing hypertension compared to those without (hazard ratio [HR], 1.24; 95% CI, 1.117 – 1.39; P <.001). When adjusting for variables including age, gender, race, plus the interaction term between diabetes mellitus status and gender, investigators observed that the prevalence was 31% greater among those with diabetes mellitus (HR, 1.31; 95% CI, 1.12 – 1.53; P = .001).

The team additionally observed that gender was a significant modifier of the associated; females ≥65 years old were 24% less likely to develop hypertension (HR, 0.76; 95% CI, 0.61 – 0.95; P = .016).

“Diabetes mellitus is associated with an increased risk of developing hypertension in the elderly, while elderly female with diabetes mellitus has a lower risk compared to male,” investigators wrote. “Long-term exposure to dysglycemic state and sex hormones may contribute at least in part to developing the risk for hypertension.”

References

1. ^{Tantisattamo E, Kookanok C, Rodsom K, Noree W, et al. Association between Diabetes Mellitus and Incidence of Hypertension in An Elderly Population. Poster presented at: National Kidney Foundation 2024 Spring Clinical Meeting (SCM). Long Beach, CA. May 14 – 18, 2024.}
2. ^{Glazier JJ. Pathophysiology, Diagnosis, and Management of Hypertension in the Elderly. Int J Angiol. 2022;31(4):222-228. Published 2022 Nov 29. doi:10.1055/s-0042-1759486}