Introduction
Whether diabetes is associated with hypertension risk remains controversial, potentially
owing to the confounding effect of lifestyle. This study aims to analyze the association
between diabetes and hypertension in adults and the mediating impacts of lifestyle.
Methods
A cohort of Spanish workers (aged 18–64 years) insured by an occupational risk prevention
company participated in this nationwide cross-sectional study between 2012 and 2016
(data analysis was performed in 2021). Participants’ lifestyle‒related factors—BMI,
sleeping hours, alcohol, smoking, and physical activity—were assessed, and the prevalence
of hypertension and diabetes was registered.
Results
A total of 451,157 participants (33.1% women, aged 44.5 [SD=9.2] years, 3.2% with
diabetes, and 29.3% with hypertension) with complete data for all variables were assessed.
Having diabetes was associated with a higher prevalence of hypertension even after
adjusting for all lifestyle-related factors (OR=1.44, 95% CI=1.43, 1.48), and people
with diabetes and hypertension had a higher prevalence of mild kidney function impairment
than people with diabetes alone (OR=1.06, 95% CI=1.01, 1.13). However, people with
diabetes and an optimal lifestyle—normal weight and sleeping hours, absent-to-little
alcohol drinking, nonsmoking, and regular physical activity—presented a prevalence
of hypertension comparable with that of those without diabetes (OR=1.00, 95% CI=0.71,
1.32). In separate analyses among people with diabetes, an optimal lifestyle was associated
with a lower prevalence of hypertension than the worse—opposite—lifestyle (OR=0.29,
95% CI=0.18, 0.53). The lifestyle-related factors showing the strongest inverse association
with adjusted risk of hypertension were normal weight (OR=0.49, 95% CI=0.42, 0.53
versus overweight/obesity) and regular physical activity (OR=0.79, 95% CI=0.74, 0.82
versus inactivity).
Conclusions
Diabetes is positively and largely independently associated with hypertension risk.
Yet, a healthy lifestyle can attenuate this association.
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Article Info
Publication History
Published online: March 24, 2022
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© 2022 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
