The Prevalence of Hypertension and Influencing Factors in Hospitalized Patients with Type 2 Diabetes in A Tertiary Care Center

Öz

Background: Diabetes and hypertension are common diseases that increase the risk of each other and may also cause cardiac, vascular and renal complications. Although the prevalence of hypertension in outpatients with diabetes has been studied several time, information about inpatients is limited. We aimed to investigate the prevalence of hypertension in hospitalized diabetic patients.
Materials and Methods: Patients with type 2 diabetes mellitus hospitalized for any reason were included to the study. Hypertension was defined as taking antihypertensive drugs or having at least two arterial blood pressure greater than 140/90 mmHg in hospital.
Results: The prevalence of hypertension in hospitalized type 2 diabetes patients was 52.6%. Blood pressure was not under control in 29 (29.5%) of 98 patients who used anti-hypertensive drug. The ages and body mass index (BMI) of patients with hypertension were significantly higher than those without hypertension (63.2 ± 10.4 vs. 55.3 ± 11.2, p <0.001 for age; 31.0 ± 6.8 vs. 27.5 ± 5.6 for BMI, p <0.001 ). The frequency of smokers was significantly higher in patients without hypertension (67.0%) than in those with hypertension (45.5%) (p=0.004). The creatinine level was found to be significantly higher in diabetics with hypertension (1.2 ± 1.0) than in those without hypertension (1.0 ± 0.5) (p=0.038).
Conclusions: Inpatients with type 2 diabetes mellitus may often be accompanied by hypertension during hospi-talization. Blood pressure of one third of these patients is not under control and this situation may negatively contribute to diabetes-related complications. The presence and treatment of hypertension in individuals with diabetes must be questioned.

Keywords: Type 2 diabetes mellitus, Hypertension, Complication

Anahtar Kelimeler

• type 2 diabetes
• hypertension
• inpatient

Üçüncü Basamak Bir Hastanede Yatan Tip 2 Diyabetli Hastalarda Hipertansiyon Sıklığı ve Etkileyen Faktörler

Öz

Amaç: Diyabet ve hipertansiyon birbirlerinin bulunma riskini arttıran, ayrıca kardiyak, vasküler ve renal kompli-kasyonlara neden olabilen yaygın hastalıklardır. Ayaktan takip edilen diyabetli hastalarda hipertansiyon sıklığı çoğu kez çalışılmışsa da yatan hastalar ile ilgili bilgiler kısıtlıdır. Biz de hastaneye yatan diyabetli hastalarda hipertansiyon sıklığını araştırmayı amaçladık.
Materyal ve metod: Herhangi bir nedenle servise yatırılan tip 2 diyabetes mellituslu hastalar çalışmaya alındı. Hipertansiyon, antihipertansif ilaçlar almak veya hastanede ölçülen arteryel kan basıncının en az iki kez 140/90 mmHg’den daha yüksek çıkması olarak tanımlandı.
Bulgular: Hastanede yatan tip 2 diyabet hastalarında hipertansiyon sıklığı %52.6 olarak bulundu. Hipertansiyonu olan ve ilaç kullanan 98 hastanın 29’unda (%29.5) kan basıncı kontrol altında değildi. Hipertansiyonu olanların yaşları ve vücut kütle indeksleri (VKİ), hipertansiyonu olmayanlara göre anlamlı olarak daha yüksekti (yaş için 63.2 ± 10.4’e karşın 55.3 ± 11.2, p <0.001; VKİ için 31.0 ± 6.8’e karşın 27.5 ± 5.6, p <0.001). Sigara içenlerin sıklığı hipertansiyonu olmayanlarda (%67.0), olanlara göre (%45.5) anlamlı olarak daha fazlaydı (p=0.004). Kreatinin düzeyi hipertansiyonu olan diyabetlilerde (1.2 ± 1.0), olmayanlara (1.0 ± 0.5) göre anlamlı olarak yüksek bulundu (p=0.038).
Sonuç: Yatarak tedavi edilen tip 2 diyabetli hastalarda, yatış sırasında hipertansiyon sıklıkla eşlik edebilmektedir. Bu hastaların ise üçte birinde kan basınçları kontrol altında olmayıp bu durum diyabetle ilişkili komplikasyonlara olumsuz katkıda bulunabilir. Diyabeti olan bireylerde hipertansiyonun varlığı tespit edilmeli ve tedavisi mutlaka gözden geçirilmelidir.

Anahtar Kelimeler: Tip 2 diyabetes mellitus, Hipertansiyon, Komplikasyon

Anahtar Kelimeler

• tip 2 diyabetes mellitus
• hipertansiyon
• yatan hasta

Kaynakça

1. 1. Ali W, Bakris GL. How to Manage Hypertension in People With Diabetes. Am J Hypertens 2020; 33(10): 935-943.
2. 2. Rabizadeh S, Gholami B, Mahmoudzadeh Kani S, Rajab A, Farrokhpour H, Esteghamati A, Nakhjavani M. Uncontrolled hypertension in patients with type 2 diabetes: What are the correlates? J Clin Hypertens (Greenwich) 2021; 23(9): 1776-1785.
3. 3. Hu FB, Stampfer MJ. Insulin resistance and hypertension: the chickenegg question revisited. Circulation 2005;112:1678–1680.
4. 4. Sabuncu T, Sonmez A, Eren MA, Sahin I, Çorapçioğlu D, Üçler R ve ark. TEMD Study Group. Characteristics of patients with hypertension in a population with type 2 diabetes mellitus. Results from the Turkish Nationwide SurvEy of Glycemic and Other Metabolic Parameters of Patients with Diabetes Mellitus (TEMD Hypertension Study). Prim Care Diabetes 2021;15(2):332-339.
5. 5. Wielgosz A, Dai S, Walsh P, McCrea-Logie J, Celebican E. Comorbid Conditions in Canadians Hospitalized Because of Diabetes. Can J Diabetes 2018; 42(1):106-111.
6. 6. Tatsumi Y, Ohkubo T. Hypertension with diabetes mellitus: significance from an epidemiological perspective for Japanese. Hypertens Res 2017 ;40(9):795-806.
7. 7. Yildiz M, Esenboğa K, Oktay AA. Hypertension and diabetes mellitus: highlights of a complex relationship. Curr Opin Cardiol 2020;35(4):397-404.
8. 8. National High Blood Pressure Education Program Working Group report on hypertension in diabetes. Hypertension 1994;23(2):145-58; discussion 159-160.

9. 9. Kahya Eren N, Harman E, Dolek D, Tütüncüoğlu AP, Emren SV, Levent F et al. Rate of blood pressure control and antihypertensive treatment approaches in diabetic patients with hypertension. Turk Kardiyol Dern Ars 2014;42(8):733-740.
10. 10. Gundogan K, Bayram F, Gedik V, Kaya A, Karaman A, Demir O, Sabuncu T, Kocer D, Coskun R. Metabolic syndrome prevalence according to ATP III and IDF criteria and related factors in Turkish adults. Arch Med Sci 2013;9(2):243-253.
11. 11. Sengul S, Akpolat T, Erdem Y, Derici U, Arici M, Sindel S et al. Turkish Society of Hypertension and Renal Diseases. Changes in hypertension prevalence, awareness, treatment, and control rates in Turkey from 2003 to 2012. J Hypertens 2016; 34(6):1208-1217.
12. 12. Akbar DH. Is hypertension common in hospitalized type 2 diabetic patients? Saudi Med J 2001;22(2):139-141.
13. 13. Sun Z. Aging, arterial stiffness, and hypertension. Hypertension 2015 ;65(2):252-6.
14. 14. Doumas M, Papademetriou V, Faselis C, Kokkinos P. Gender differences in hypertension: myths and reality. Curr Hypertens Rep 2013;15(4):321-330.
15. 15. Sowers JR. Diabetes mellitus and vascular disease. Hypertension 2013;61(5):943-947.
16. 16. Brands MW. Role of Insulin-Mediated Antinatriuresis in Sodium Homeostasis and Hypertension. Hypertension 2018;72(6):1255-1262.
17. 17. Rhee MY, Na SH, Kim YK, Lee MM, Kim HY. Acute effects of cigarette smoking on arterial stiffness and blood pressure in male smokers with hypertension. Am J Hypertens 2007;20(6):637-641.
18. 18. Bowman TS, Gaziano JM, Buring JE, Sesso HD. A prospective study of cigarette smoking and risk of incident hypertension in women. J Am Coll Cardiol 2007;50(21):2085-2092.
19. 19. Kim BJ, Han JM, Kang JG, Kim BS, Kang JH. Association between cotinine-verified smoking status and hypertension in 167,868 Korean adults. Blood Press 2017;26(5):303-310.
20. 20. Ku E, Lee BJ, Wei J, Weir MR. Hypertension in CKD: Core Curriculum 2019. Am J Kidney Dis 2019; 74(1):120-131.