Background:Whether the combination of different blood pressure and arterial stiffness (AS) status is independently associated with diabetes has not been fully investigated so far. This study aimed at investigating the status of hypertension and AS in determining diabetes.Methods:This prospective cohort study included 11 156 participants from the Kailuan study. AS was measured by brachial-ankle pulse wave velocity. We compared the risk of diabetes between individuals with ideal vascular function (defined as normotension with normal AS), normotension with elevated AS, hypertension with normal AS, and hypertension with elevated AS.Results:After a median follow-up of 6.16 years, diabetes occurred in 768 participants. Compared with ideal vascular function group, the highest risk of diabetes was observed in hypertension with elevated AS group (hazard ratio, 2.42 [95% CI, 1.93–3.03]), followed by normotension with elevated AS group (hazard ratio, 2.11 [95% CI, 1.68–2.66]), hypertension with normal AS group exhibited the lowest risk of diabetes (hazard ratio, 1.48 [95% CI, 1.08–2.02]). Multiple sensitivity and subgroup analyses yielded similar results. Furthermore, the additional of AS to a conventional model including traditional risk factors had a higher incremental effect on the predictive value for diabetes than the addition of hypertension (the C statistics was 0.707 versus 0.695; the integrated discrimination improvement was 0.65% versus 0.28%; net reclassification improvement was 40.48% versus 34.59%).Conclusions:Diabetes is associated with not only hypertension but also AS. Additionally, AS shows a better predictive ability than hypertension in predicting diabetes.

中文翻译：

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高血压、动脉僵硬和糖尿病：一项前瞻性队列研究

背景：目前尚未充分研究不同血压和动脉僵硬度（AS）状态的组合是否与糖尿病独立相关。本研究旨在调查高血压和AS在确定糖尿病中的地位。方法：这项前瞻性队列研究包括来自开滦研究的11 156名参与者。AS通过臂踝脉搏波速度测量。我们比较了具有理想血管功能（定义为血压正常且 AS 正常）、血压正常且 AS 升高、高血压伴 AS 正常和高血压伴 AS 升高的个体之间患糖尿病的风险。结果：中位随访 6.16 年后，糖尿病发生在 768 名参与者中。与理想血管功能组相比，在高血压伴 AS 升高组中观察到糖尿病的最高风险（风险比，2.42 [95% CI，1.93-3.03]），其次是血压正常且 AS 升高组（风险比，2.11 [95% CI，1.68-2.66] ），正常 AS 组的高血压患者患糖尿病的风险最低（风险比，1.48 [95% CI，1.08-2.02]）。多重敏感性和亚组分析产生了相似的结果。此外，在包括传统危险因素的传统模型中添加 AS 对糖尿病预测值的增量影响比添加高血压更高（C 统计量为 0.707 对 0.695；综合辨别力提高为 0.65% 对 0.28%；净重分类改善分别为 40.48% 和 34.59%）。结论：糖尿病不仅与高血压有关，还与 AS 相关。此外，