Glycated Hemoglobin and Risk of Hypertension in the Atherosclerosis Risk in Communities Study

Diabetes Care, 04/02/2012

Bower JK et al. - The authors observed that individuals with elevated HbA1c, even without a prior diabetes diagnosis, are at increased risk of hypertension. glycated hemoglobin (HbA1c) is a known predictor of incident heart disease and stroke. The results suggest that the association of HbA1c with cardiovascular risk may be partially mediated by the development of hypertension.


  • The authors conducted a prospective analysis of 9,603 middle-aged participants in the Atherosclerosis Risk in Communities Study without hypertension at baseline.
  • Using Cox proportional hazards models, the authors estimated the association between HbA1c at baseline and incident hypertension by two definitions 1) self-reported hypertension during a maximum of 18 years of follow-up and 2) measured blood pressure or hypertension medication use at clinic visits for a maximum of 9 years of follow-up.


  • The authors observed 4,800 self-reported and 1,670 visit-based hypertension cases among those without diagnosed diabetes at baseline.
  • Among those with diagnosed diabetes at baseline, the authors observed 377 self-reported and 119 visit-based hypertension cases.
  • Higher baseline HbA1c was associated with an increased risk of hypertension in subjects with and without diabetes.
  • Compared with nondiabetic adults with HbA1c <5.7%, HbA1c in the prediabetic range (5.7–6.4%) was independently associated with incident self-reported hypertension (hazard ratio 1.14 [95% CI 1.06–1.23]) and visit-detected hypertension (1.17 [1.03–1.33]).

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