New-onset diabetes in hypertensive patients and mortality: timing is everything

This editorial refers to ‘Contrasting mortality risks among subgroups of treated hypertensive patients developing new-onset diabetes’[†][1], by S. Lip et al ., on page 968. Arterial hypertension and type 2 diabetes mellitus are well known cardiovascular (CV) risk factors, which are often associated.1 In a large, prospective cohort study including 12 550 adults, the development of type 2 diabetes was almost 2.5 times as likely in patients with hypertension than in their normotensive counterparts. It is common knowledge that prevalent and new-onset diabetes in hypertensive patients are associated with a two- to three-fold higher risk of CV disease.2 Furthermore, a recent analysis of the Framingham data showed that the population with prevalent hypertension at the time of diagnosis of diabetes mellitus had higher rates of all-cause and CV mortality, thus suggesting that much of this excess risk is attributable to co-existent hypertension.3 This strong piece of evidence led to the classification of hypertensive patients with diabetes mellitus automatically at very high CV risk by ESC/ESH Guidelines.4 For that reason, in the past years lower blood pressure (BP) targets had been recommended for this subgroup of patients,5 although no evidence from randomized clinical trials supported this suggestion. Indeed, the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study failed to demonstrate a significant reduction in incidence of CV events when lowering … [1]: #fn-2