Hypertension in a defined population. The Skaraborg Hypertension and Diabetes Project

Abstract: To examine cardiovascular disease risk factors, control of hypertension and survival in patients with hypertension treated in primary care, patients with hypertension and/or type 2 diabetes were surveyed for cardiovascular disease risk factors and treatment 1992-1993. For reference, a random population sample from the same community was surveyed 1993-1994. During 1998, antihypertensive prescriptions were registered. Vital status was ascertained until year 2000. The proportion of hypertension among patients with type 2 diabetes was 57%, and the proportion of type 2 diabetes among patients with hypertension was 26%. Compared to patients with hypertension alone, patients with both hypertension and type 2 diabetes had higher fasting blood glucose, fasting triglycerides, BMI and blood pressure. High fasting blood glucose, fasting triglycerides, obesity, insulin resistance and microalbuminuria were associated with diastolic blood pressure >=90 mmHg in women. Fasting blood glucose and known type 2 diabetes predicted mortality in both genders. Diastolic blood pressure >=90 mmHg predicted mortality in women. A significant decrease in prescriptions of calcium antagonists that was observed during 1996-1998 seemed to be initiated by reports on side-effects from these drugs, and a debate on drug costs. The coexistence of hypertension and type 2 diabetes was higher than previously demonstrated in Sweden. These patients were characterised by having a cluster of the metabolic syndrome risk factors, less controlled diastolic blood pressure and a high mortality, eliminating the female advantage in survival. All risk factors should be identified and treated in such patients with emphasis on means to reduce insulin resistance.