Are blood pressure and diabetes additive or synergistic risk factors? Outcome in 8494 subjects randomly recruited from 10 populations

Thomas Sehestedt, Tine W. Hansen, Yan Li, Tom Richart, Jose Boggia, Masahiro Kikuya, Lutgarde Thijs, Katarzyna Stolarz-Skrzypek, Edoardo Casiglia, Valerie Tikhonoff, Sofia Malyutina, Yuri Nikitin, Kristina Bjorklund-Bodegard, Tatiana Kuznetsova, Takayoshi Ohkubo, Lars Lind, Christian Torp-Pedersen, Jorgen Jeppesen, Hans Ibsen, Yutaka ImaiJiguang Wang, Edgardo Sandoya, Kalina Kawecka-Jaszcz, Jan A. Staessen*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


It remains unknown whether diabetes and high blood pressure (BP) are simply additive risk factors for cardiovascular outcome or whether they act synergistically and potentiate one another. We performed 24-h ambulatory BP monitoring in 8494 subjects (mean age, 54.6 years; 47.0% women; 6.9% diabetic patients) enrolled in prospective population studies in 10 countries. In multivariable-adjusted Cox regression, we assessed the additive as opposed to the synergistic effects of BP and diabetes in relation to a composite cardiovascular endpoint by testing the significance of appropriate interaction terms. During 10.6 years (median follow-up), 1066 participants had a cardiovascular complication. Diabetes mellitus as well as the 24-h ambulatory BP were independent and powerful predictors of the composite cardiovascular endpoint. However, there was no synergistic interaction between diabetes and 24-h, daytime, or nighttime, systolic or diastolic ambulatory BP (P for interaction, 0.07
Original languageEnglish
Pages (from-to)714-721
JournalHypertension Research
Issue number6
Publication statusPublished - Jun 2011


  • ambulatory blood pressure
  • cardiovascular risk factors
  • diabetes mellitus
  • epidemiology
  • population science

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