A Descriptive Analysis of Diabetic Complications and Antihypertensive Use Among Pima Indians

Abstract

Objectives: To determine the effect of antihypertensive use on renal function and other diabetic complications in adults over the age of 18 with type 2 diabetes mellitus (DM). Methods: A retrospective secondary analysis of the NIH Pima epidemiologic data included 1,828 individuals with type 2 DM were evaluated for antihypertensive use and DM complications. Statistical analysis was done using general linear model regression (GLM) or logistic regression models controlling for age, sex and DM duration. Three groups were established to evaluate antihypertensive use Group 1 those taking antihypertensives to those not taking antihypertensives, Group 2 those taking more than one (multiple) antihypertensives to those only taking one and Group 3 those taking an angiotensin converting enzyme (ACE) inhibitor to those not taking an ACE. Results: Group 1 those taking antihypertensives were significantly worse for all outcome measures than those taking no antihypertensives as evident with: renal function (ACR 43 mg/mmol versus 15.9 mg/mmol (ρ=0.0003) and albuminuria 55.8% versus 37.6% (p=0.0039), retinopathy, neuropathy and CVD. Group 2 those taking multiple antihypertensives had significantly worse renal function (ACR 69.2 mg/mmol versus 34.5 mg/mmol (p=0.0329) and albuminuria 63% versus 52% (p=0.0396)), CVD while retinopathy and neuropathy were not significantly different. Group 3 those taking ACE had significantly worse renal function (ACR 43.8 mg/mmol versus 35.2 mg/mmol (p=0.0329)) while CVD was improved and no difference was observed in retinopathy and neuropathy. Conclusions: Antihypertensive use had little impact on preventing diabetic complications. This is contrary to well- documented literature that supports the use of antihypertensives to slow disease progression and protect renal function.