Diabete s & hy p e r te n sio n

Transcription

1 4 Dabt s & hy p r t n so n I was not awar of how hgh blood prssur can affct th kdnys. I was talkng othr popl who had attndd (th scrnng) and th commnts wr vry postv. Svral told m thy dd not know thy had sugar dabts. Whn I go to my doctor now I mak sur h chcks my urn. Thank you! KEEP partcpant: Scrnng dat, August, 25 d a b t s g l y c m c c o n t r o l h y p r t n s o n b l o o d p r s s u r c o n t r o l & r s k f a c t o r s f o r h y p r t n s o n Chaptr 4 Dabts and hyprtnson s47

2 t t ) t t t t t t t dabts s l a b 4 3 Ag Gndr Rac/thncty Elvatd blood sugar s a b 3 2 h d P r c n t w 2 1 All Mal Fmal Wht Black Othr Hspanc h d P r c n t w 1 Slf-rportd Elvatd blood sugar KEEP partcpants dabts, by ag, gndr, & rac/thncty KEEP N= 53,217, ag; 53,152, gndr; 52,95, rac. 4.2 KEEP partcpants dabts, by cohort yar KEEP N= 53,217. s b a 3 2 s a b 4 KEEP 3 NHANES 99-2 Slf-rportd Elvatd blood sugar t h d t w n c r P 1 Slf-rportd Elvatd blood sugar Northast Mdwst South Wst h d P r c n t w 2 1 <HS&NIns <HS&Ins HS+&NIns HS+&Ins <HS&NIns <HS&Ins HS+&NIns HS+&Ins 4.3 KEEP partcpants dabts, by U.S. Cnsus Rgon KEEP N= 53, KEEP & NHANES partcpants dabts, by ducaton & nsuranc status KEEP N= 5,615. NHANES N= 11,165, slf-rportd dabts; 9,683, lvatd blood sugar. 6 g m 6 s n a p c r a f p t o n c r P Mcroalbumn + ACR >3 mg/g All DM NDM l ( v n l m u b a o r c n m a M Mcroalbumnura & ACR n KEEP partcpants, by dabtc status KEEP N= 48,397; 44,68, ACR. Postv mcroalbumn, >2mg/L. 4 2 All DM NDM abts and hyprtnson ar two cntral halth ssus facng th U.S. populaton, and ar major targts of th KEEP program. Twnty-sx prcnt of KEEP partcpants rport havng dabts, whl 17.1% hav an lvatd blood sugar. In partcpants ag 61 75, 38% rport havng dabts, and dabts s prsnt n 27% and 25% of mn and womn, rspctvly. By, rac/thncty, dabts s most promnnt n ndvduals of othr racs, at 28.1%, followd by 26.4% n whts, s48 Natonal Kdny Foundaton Kdny Early Evaluaton Program 26

3 kp partcpants, by dabtc status and famly hstory blood prssur (mmhg) lvatd blood prssur ) GFR (ml/mn/1.73m Man 96 N /EBS N /EBS % N /EBS N /EBS Man 7 N /EBS N /EBS 4.6 Man blood prssur KEEP N= 54, Elvatd blood prssur KEEP N= 54, Man GFR KEEP N= 52,892. CKD N /EBS N /EBS 2 ) Man BMI (kg/m N /EBS N /EBS BMI 3 kg/m 2 ) N /EBS N /EBS 4.9 Prsnc of CKD KEEP N= 45, Man BMI KEEP N= 54, BMI 3 kg/m2 KEEP N= 54, % n Hspancs, and 23.6% n blacks. Indvduals rsdng n th Wst hav th lowst rats of dabts, at 24%. Dabts s most common n KEEP and NHANES partcpants who ar nsurd and hav lss than a hgh school ducaton, at 38.1 and 9.7%, whl n thos lss than a hgh school ducaton and no nsuranc rats of dabts stand at 27.3 and 8.8%. Ffty-four prcnt of KEEP partcpants dabts hav a postv urnary albumn tst, n comparson to 44% n thos out dabts. Man blood prssur s hghst n KEEP partcpants who rport no dabts or famly hstory of th dsas but who do hav an lvatd blood sugar. Among KEEP partcpants, th lowst stmatd glomrular fltraton lvls (GFRs) occur n thos who rport havng dabts but do not hav a famly hstory of th dsas, and rats of CKD ar hghst n ths ndvduals, at 41.7%. Man BMI s hghst, at 32.6%, n KEEP partcpants who rport havng dabts and a famly hstory of th dsas 59% of ths ndvduals hav a BMI qual to or xcdng 3 kg/m 2. Chaptr 4 Dabts and hyprtnson s49

4 glycmc control Kp partcpants or out slf-rportd dabts Man blood sugar (mg/dl) Slf-rportd non-dabts Pr HTN Stag 1 Stag 2 % n targt blood sugar Slf-rportd non-dabts All Pr HTNStag 1 Stag 2 % mtng targt blood sugar Man blood sugar, by hyprtnsv stag (JNC 7) KEEP N= 52, Partcpants who mt th targt blood sugar lvl, by HTN stag (JNC 7) KEEP N= 52, Partcpants who mt th targt blood sugar lvl, by cohort yar KEEP N= 53,749. % mtng targt blood sugar Slf-rportd non-dabts Northast Mdwst South Wst Man blood sugar (mg/dl) Slf-rportd non-dabts Physcan No physcan lvatd blood sugar Slf-rportd non-dabts Physcan No physcan 4.15 Partcpants mtng th targt blood sugar lvl, by U.S. Cnsus rgon KEEP N=53, Man blood sugar, by physcan ntracton KEEP N= 51, Elvatd blood sugar, by physcan ntracton KEEP N= 51,778. ghty-four prcnt of KEEP partcpants mt th targt blood sugar lvl (fastng <126 mg/dl, non-fastng <139 mg/dl) n 25, compard to 81.6% n In KEEP partcpants slf-rportd dabts, man blood sugar lvls ncras th svrty of hyprtnson, rangng from mg/dl n thos classfd as havng a normal blood prssur (JNC 7) to mg/dl n thos dntfd as havng Stag 2 hyprtnson. Partcpants normal or prhyprtnsv classfcatons ar th most lkly to mt th targt blood sugar lvl. Across U.S. Cnsus Rgons, 5 55% of KEEP partcpants slf-rportd dabts, and ovr 9% of thos rportng no dabts, mt th targt blood sugar lvl. Of KEEP partcpants slf-rportd dabts, 47.8% who rportd havng a physcan had an lvatd blood sugar compard to 5.1% of thos out a physcan. Physcan ntracton plays an mportant rol n blood sugar lvl; lvls n partcpants rportng thy hav a physcan ar 2 mg/dl lowr than thos n partcpants out a physcan. In slf-rportd non-dabtc KEEP partcpants, th odds of an lvatd blood sugar ar 36% hghr for thos ag than for thos ag 46 6, 24.5% hghr for mn than for womn, 58% hghr for thos a BMI qual to or xcdng 3 kg/m 2, and 22.4% hghr n thos CKD. In KEEP partcpants dabts, th odds of havng a blood sugar lvl n th targt rang ar 37% hghr n partcpants ag 18 3 than n thos ag 46 6, 26% lowr n mals, 19% lowr n ndvduals a BMI qual to or xcdng 3 kg/m 2, and 24% lowr n thos CKD. s5 Natonal Kdny Foundaton Kdny Early Evaluaton Program 26

5 RR lowr uppr p-valu < < <.1 > mal <.1 black othr <.1 Smokng & usd to smok Slf-rportd HTN Famly hstory of dabts <.1 Famly hstory of hyprtnson BMI <.1 CKD Northast Mdwst Wst Odds rato of an lvatd BS Mal Smokng SRHTN FHDM BMI 3 CKD 4.a Odds of slf-rportd non-dabtc KEEP partcpants havng an lvatd blood sugar KEEP N= 28, Odds of slf-rportd non-dabtc KEEP partcpants havng an lvatd blood sugar, by rsk factor KEEP N= 9,785. RR lowr uppr p-valu > mal <.1 black othr <.1 Smokng & usd to smok Slf-rportd HTN Famly hstory of dabts Famly hstory of hyprtnson BMI <.1 CKD <.1 Northast Mdwst Wst Odds rato of BS n targt rang Mal Smokng SRHTN FHDM BMI 3 CKD 4.b Odds of mtng th targt blood sugar lvl n known KEEP dabtc partcpants KEEP N= 28, Odds of bng n th targt blood sugar lvl n known KEEP partcpants dabts, by rsk factor KEEP N= 9,785. Rfrnc groups: ag 46 6, fmal, wht, nvr smokd, no slf-rportd hyprtnson, no famly hstory of dabts, no famly hstory of hyprtnson, BMI <3 kg/m 2, no CKD, and South. Chaptr 4 Dabts and hyprtnson s51

6 hyprtnson hyprtnson Ag Gndr Rac/thncty Slf-rportd hyprtnson Elvatd blood prssur hyprtnson All Mal Fmal Wht Black Othr Hspanc 2 Slf-rportd hyprtnson Elvatd blood prssur KEEP partcpants hyprtnson, by ag, gndr, & rac/thncty KEEP N= 53,681, ag; 53,612 gndr, 52,541 rac KEEP partcpants hyprtnson, by cohort yar KEEP N= 53,681. hyprtnson 6 4 hyprtnson KEEP NHANES 99-2 Slf-rportd hyprtnson Elvatd blood prssur 2 Slf-rportd hyprtnson Elvatd blood prssur Northast Mdwst South Wst 4 2 <HS & NINS <HS & INS HS+ & NINS HS+ & INS <HS & NINS <HS & INS HS+ & NINS HS+ & INS 4.22 KEEP partcpants, by U.S. Cnsus Rgon KEEP N= 53, KEEP & NHANES partcpants hyprtnson, by ducaton & nsuranc status KEEP N= 51,33. NHANES N= 11,14, slf-rportd hyprtnson; 9,275, lvatd blood prssur. h prcnt of KEEP partcpants hyprtnson has rmand stabl, by yar, at 5 56%. Ovrall, mor than half of lgbl KEEP partcpants rport havng hyprtnson or hav an lvatd blood prssur. Black partcpants ar most lkly to rport havng hyprtnson or to hav an lvatd blood prssur, at 56.6 and 55.5% rspctvly, followd by whts at 53.8 and 56.6%. A gratr prcntag of KEEP partcpants lvng n th Mdwst or th South hav hyprtnson compard to thos lvng n th Northast or Wst. Mcroalbumnura s prsnt n 49.7% of KEEP partcpants hyprtnson compard to 42.2% n thos out th dagnoss, whl man mcroalbumn lvls ar 37 and 25 mg, rspctvly. Man blood prssur n KEEP partcpants has falln by only 2% snc th bgnnng of th study, and s hghst n thos who rport no hyprtnson but hav an lvatd blood prssur and a famly hstory of th condton. Narly 7% of KEEP partcpants slf-rportd hyprtnson hav a masurd lvatd blood prssur. Man GFR s lowst n KEEP partcpants who rport bng hyprtnsv but do not hav a famly hstory of th condton. CKD s most common n ths ndvduals. Man BMI s hghst n KEEP partcpants who rport bng hyprtnsv and hav a famly hstory of th condton. Of KEEP partcpants slf-rportd hyprtnson and a famly hstory of th condton, 54% hav a BMI qual to or gratr than 3 kg/m 2. s52 Natonal Kdny Foundaton Kdny Early Evaluaton Program 26

7 mcroalbumnura All HTN NHTN Man mcroalbumn lvl (mg) All HTN NHTN Blood prssur (mmhg) systolc man dastolc puls prssur (sytolc -dastolc) Mcroalbumnura n KEEP partcpants, by hyprtnsv status KEEP N= 49,814. Postv mcroalbumn, >2mg/L 4.25 Blood prssur paramtrs n KEEP partcpants, by cohort yar KEEP N= 54,32. kp partcpants, by hyprtnsv status and famly hstory Man blood prssur (mmhg) N N /EBS /EBS lvatd BP N N /EBS /EBS Man GFR (ml/mn/1.73 m 2 ) N N /EBS /EBS 4.26 Man blood prssur KEEP N= 54, Elvatd blood prssur KEEP N= 54, Man GFR KEEP N= 52,887. CKD N N /EBS /EBS 2 ) Man BMI (kg/m N N /EBS /EBS BMI 3 kg/m 2 ) N N /EBS /EBS 4.29 Prsnc of CKD KEEP N= 45, Man BMI KEEP N= 54, BMI 3 kg/m2 KEEP N= 54,463. Chaptr 4 Dabts and hyprtnson s53

8 blood prssur control & rsk factors for hyprtnson n KEEP partcpants, man blood prssur ncrass BMI, and s narly 3 mmhg lowr n thos a physcan. Of KEEP partcpants who s a physcan, 54% had and lvatd blood prssur. In slf-rportd non-hyprtnsv KEEP partcpants a blood rlatv who has had a hart attack or strok, or who has PVD, a famly hstory of cardovascular dsas dos not appar to sgnfcantly nflunc th chancs of havng a rsk factor for hyptnson. Th odds of an lvatd blood prssur n KEEP partcpants out slf-rportd hyprtnson and ag 75 and oldr ar mor than doubl thos found n partcpants ag 46 6, and ar twc as hgh n partcpants a BMI qual to or xcdng 3 kg/m 2 compard to thos a normal BMI. Th odds of an lvatd blood prssur ar thr tms hghr n thos dabts compard to thos out th dsas. (mmhg) prssur blood Man 4.32 Man blood prssur (mmhg) BP targt mtng All < All < Man blood prssur n KEEP partcpants slf-rportd hyprtnson, by BMI KEEP N= 27, Physcan No physcan Man blood prssur n KEEP partcpants slf-rportd hyprtnson, by physcan ntracton KEEP N= 27, BP lvatd Targt blood prssur (JNC 7) n KEEP partcpants slf-rportd hyprtnson, by BMI KEEP N= 28, Physcan No physcan KEEP partcpants outsd th targt blood prssur rang (JNC 7), by physcan ntracton KEEP N= 27,595. a rsk factor for HTN Dabts BMI 3 Elvatd Blood Prssur Hstory of smokng All No FH CVD FHCVD partcpants of 4 Non All No FH CVD FHCVD 4.36 Rsk factors for HTN n KEEP partcpants, by famly hstory of PVD KEEP N= 5, Numbr of rsk factors for hyprtnson n KEEP partcpants, by famly hstory of PVD KEEP N= 5,572. s54 Natonal Kdny Foundaton Kdny Early Evaluaton Program 26

9 RR Low Uppr P-valu < < <.1 > <.1 Mal <.1 Black Othr rac Smokng & usd to smok <.1 Famly hstory of dabts Famly hstory of hyprtnson <.1 BMI <.1 CKD <.1 Northast <.1 Mdwst Wst Odds rato of an lvatd BP Mal Black Othr SRDM FHHTN CKD Smokng FHDM BMI 3 4.c Odds ratos of slf-rportd nonhyprtnsv KEEP partcpants havng lvatd blood prssur (JNC 7) KEEP N= 17, Odds of slf-rportd non-hyprtnsv KEEP partcpants havng an lvatd blood prssur, by rsk factor KEEP N= 17,869. RR Low Uppr P-valu < < <.1 > <.1 Mal <.1 Black <.1 Othr rac Smokng & usd to smok <.1 Famly hstory of dabts Famly hstory of hyprtnson BMI <.1 CKD <.1 Northast <.1 Mdwst Wst Odds rato of mtng targt BP Mal Black Othr SRDM FHHTN CKD Smokng FHDM BMI 3 4.d Odds ratos of mtng targt blood prssur (JNC 7) n KEEP partcpants known hyprtnson KEEP N= 2, Odds of mtng targt blood prssur (JNC 7) n KEEP partcpants known hyprtnson, by rsk factor KEEP N= 2,135. Rfrnc groups: ag 46 6, fmal, wht, nvr smokd, no slf-rportd hyprtnson, no famly hstory of dabts, no famly hstory of hyprtnson, BMI <3 kg/m 2, no CKD, and South Chaptr 4 Dabts and hyprtnson s55

10 chaptr hghlghts Fgur 4.1 Twnty-sx prcnt of KEEP partcpants rport havng dabts, whl 17.1% hav an lvatd blood sugar. In partcpants ag 61 75, 38% rport havng dabts, and dabts s prsnt n 27% and 25% of mn and womn, rspctvly. Tabl 4.b In KEEP partcpants dabts, th odds of havng a blood sugar lvl n th targt rang ar 37% hghr n partcpants ag 18 3 than n thos ag 46 6, 26% lowr n mals, 19% lowr n ndvduals a BMI qual to or xcdng 3 kg/m 2, and 24% lowr n thos CKD. Fgur 4.2 Ovrall, mor than half of lgbl KEEP partcpants rport havng hyprtnson or hav an lvatd blood prssur. Black partcpants ar most lkly to rport havng hyprtnson or to hav an lvatd blood prssur, at 56.6 and 55.5% rspctvly, followd by whts at 53.8 and 56.6%. Fgur 4.21 Th prcnt of KEEP partcpants hyprtnson has rmand stabl, by yar, at 5 56%. Fgur 4.32 In KEEP partcpants, man blood prssur ncrass BMI. Tabl 4.c Th odds of an lvatd blood prssur n KEEP partcpants out slfrportd hyprtnson and ag 75 and oldr ar mor than doubl thos found n partcpants ag 46 6, and ar twc as hgh n partcpants a BMI qual to or xcdng 3 kg/m 2 compard to thos a normal BMI. Th odds of an lvatd blood prssur ar thr tms hghr n thos dabts compard to thos out th dsas. Dabts Elvatd blood sugar Dabtc Groups 1: Slf-rportd DM, (+) famly hstory 2: Slf-rportd DM, (-) famly hstory 3: Slf-rportd NDM, (+) famly hstory & lvatd blood sugar 4: Slf-rportd NDM, (-) famly hstory & lvatd blood sugar Glucos gratr than th normal lmt Fastng: >126 mg/dl Non-fastng: >139 mg/dl Elvatd blood sugar (EBS) glucos >normal lmt: fastng, >126 mg/dl; non-fastng, >139 mg/dl Elvatd albumn/cratnn rato ACR 3 mg/g Postv mcroalbumn >2 mg/l Hyprtnson Groups 1: Slf-rportd HTN, (+) famly hstory 2: Slf-rportd HTN, (-) famly hstory 3: Slf-rportd NHTN, (+) famly hstory & lvatd blood prssur 4: Slf-rportd NHTN, (-) famly hstory & lvatd blood prssur Man blood prssur (Systolc-Dastolc)/3 + Dastolc Elvatd blood prssur (EBP) (JNC 7) DM or CKD: systolc: 13 mmhg or dastolc: 8 mmhg No DM or CKD: systolc: 14 mmhg or dastolc: 9 mm Hg Rsk factors for hyprtnson Dabts Elvatd blood prssur BMI 3 Smokng hstory Hyprtnson total Slf-rportd hyprtnson Elvatd blood prssur CKD Dfnton If GFR by K/DOQI MDRD <6 ml/mn/1.73 m 2 or GFR 6 ml/mn/1.73 m 2 and abnormal albumn/cratnn rato (ACR 3mg/g) Body Mass Indx Catgors UW: undrwght, BMI <18.5 N: normal, BMI OW: ovrwght, BMI OB: obs, BMI EOB: xtrmly obs, BMI 4 Educaton & nsuranc <HS&NIns: Lss than a hgh school ducaton, & no nsuranc <HS&Ins: Lss than a hgh school ducaton, & nsuranc HS+&NIns: Hgh school ducaton or gratr, & no nsuranc HS+&Ins: Hgh school ducaton or gratr, & nsuranc s56 Natonal Kdny Foundaton Kdny Early Evaluaton Program 26