Epidemiol Health.  2018;40:e2018026. 10.4178/epih.e2018026.

Pre-hypertension and the risk of diabetes mellitus incidence using a marginal structural model in an Iranian prospective cohort study

• Khosravi A
• Emamian MH
• Hashemi H
• Fotouhi A

• KMID: 2438481
• DOI: http://doi.org/10.4178/epih.e2018026

Abstract

OBJECTIVES
The aim of this study was to evaluate the effect of pre-hypertension and its sub-classification on the development of diabetes.
METHODS
In this cohort study, 2,941 people 40 to 64 years old without hypertension or diabetes were followed from 2009 through 2014. According to the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC)-7 criteria, we classified participants into normal and pre-hypertension groups. The effect of pre-hypertension on the 5-year incidence rate of diabetes was studied using inverse probability of treatment weighting. We modeled the exposure and censored cases given confounding factors such as age, sex, body mass index, smoking, economic status, and education.
RESULTS
The 5-year incidence rate of diabetes among people with pre-hypertension and those with normal blood pressure (BP) was 12.7 and 9.7%, respectively. The risk ratio (RR) for people with pre-hypertension was estimated to be 1.13 (95% confidence interval [CI], 0.90 to 1.41). The RRs among people with normal BP and high-normal BP, according to the JNC-6 criteria, compared to those with optimal BP were 0.96 (95% CI, 0.73 to 1.25) and 1.31 (95% CI, 1.01 to 1.72), respectively.
CONCLUSIONS
Our results showed that participants who had higher levels of BP (high-normal compared to optimal BP) had a higher risk of diabetes development. With regard to the quantitative nature of BP, using the specifically distinguishing of stage 1 hypertension or high-normal BP may be a more meaningful categorization for diabetes risk assessment than the JNC-7 classification.

Keyword

Blood pressure; Causal inference; Diabetes mellitus; Inverse probability weight; Prehypertension; Iran

MeSH Terms

Blood Pressure
Body Mass Index
Classification
Cohort Studies*
Diabetes Mellitus*
Education
Hypertension
Incidence*
Iran
Joints
Models, Structural*
Odds Ratio
Prehypertension*
Prospective Studies*
Risk Assessment
Smoke
Smoking
Smoke