Diabetes modifies the association of prehypertension with cardiovascular disease and all-cause mortality

Prehypertension is a risk factor for cardiovascular disease (CVD) and all-cause mortality. However, it is unclear whether prehypertension combined with diabetes associate with a higher risk for cardiovascular disease and all-cause mortality. The purpose of this study was to explore the relationship between prehypertension and the risk of CVD and all-cause mortality was different among individuals with or without diabetes. In the prospective community-based Kailuan study, 67 344 participants without hypertension or a history of CVD at baseline (2006) were included. Prehypertension was defined as systolic blood pressure of 120-139 mmHg or diastolic blood pressure of 80-89 mmHg. The outcomes were CVD and all-cause mortality were followed up through December 31, 2017. We performed Cox proportional hazards models to evaluate the relationships between prehypertension and CVD and all-cause mortality by diabetes status. During a median follow-up of 11.03 years, 2981 CVD events and 4655 all-cause mortality occurred. After adjusting age, sex, and other factors, the associations of prehypertension with risk of CVD and all-cause mortality were significant in participants without diabetes (hazard ratio and 95% confidence interval: 1.54 [1.38-1.71] and 1.27 [1.17-1.38]), but not in participants with diabetes (1.20 [0.93-1.56] and 0.88 [0.73-1.07]). The interactions between prehypertension and diabetes for the risk of CVD and all-cause mortality were all significant (all p < .05). Prehypertension was only associated with an increased risk for CVD and all-cause mortality in non-diabetes participants. Diabetes modifies the relation of prehypertension with the risk of CVD and all-cause mortality.