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Objective: The purpose of this study was to determine the baseline predictors of new-onset diabetes (NOD) in hypertensive patients and to develop a risk score to identify those at high risk of NOD., Research Design and Methods: Among 19,257 hypertensive patients in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA) who were randomly assigned to receive one of two antihypertensive regimens (atenolol +/- thiazide or amlodipine +/- perindopril), 14,120 were at risk of developing diabetes at baseline. Of these, 1,366 (9.7%) subsequently developed NOD during median follow-up of 5.5 years. A multivariate Cox model was developed to identify the independent predictors of NOD and individual risk scores., Results: NOD was significantly associated with an increase in baseline fasting plasma glucose (FPG), BMI, serum triglycerides, and systolic blood pressure. In contrast, amlodipine +/- perindopril in comparison with atenolol +/- thiazide treatment (hazard ratio 0.66 [95% CI 0.59-0.74]), high HDL cholesterol, alcohol use, and age >55 years were found to be significantly protective factors. FPG was the most powerful predictor with risk increasing by 5.8 times (95% CI 5.23-6.43) for each millimole per liter rise >5 mmol/l. The risk of NOD increased steadily with increasing quartile of risk score, with a 19-fold increase (95% CI 14.3-25.4) among those in the highest compared with those in the lowest quartile. The model showed excellent internal validity and discriminative ability., Conclusions: Baseline FPG >5 mmol/l, BMI, and use of an atenolol +/- diuretic regimen were among the major determinants of NOD in hypertensive patients. The model developed from these data allows accurate prediction of NOD among hypertensive subjects.

Aims: To determine the prevalence of cardiovascular risk factors among hypertensives in a cross-sectional survey of hypertensives from 13 general practices in England., Findings: Of 1,948 European hypertensives (systolic blood pressure 150 mmHg and/or diastolic blood pressure > 90 mmHg and/or on treatment for hypertension), 40 to 69 years of age, 53.3% on treatment had controlled blood pressures (systolic blood pressure < 160 mmHg and diastolic blood pressure < 95 mmHg). Electrocardiographic abnormalities and other cardiovascular risk factors were common among these hypertensives, with dyslipidaemia, past or current smoking and lack of physical exercise being present in the majority of those studied. All risk factors except reported diabetes were more prevalent amongst subjects from northern practices, where coronary heart disease rates are higher. Compared with those on no therapy, those receiving diuretics only had significantly higher levels of serum total cholesterol (6.39 mmol/l vs 6.69 mmol/l: p < 0.01), and those receiving beta-blockers only had significantly higher levels of triglycerides (2.32 mmol/l vs 2.64 mmol/ l: p < 0.01), and lower levels of HDL-cholesterol (1.33 mmol/l vs 1.23 mmol/l: p < 0.001)., Conclusion: It is important to consider other cardiovascular risk factors in hypertensives because they are very common and interact with blood pressure (BP) to determine levels of risk. The high proportion of inadequately controlled hypertensives demands a more effective management strategy.

100 patients with essential hypertension (77 whites, 23 black) were studied with measurements of plasma noradrenaline concentration and plasma renin activity. Black patients had higher blood pressure than whites. There were no ethnic differences in mean plasma noradrenaline, but plasma renin activity was lower in blacks than whites, and this difference was not related to differences in sodium intake. Plasma noradrenaline increased with age in blacks, and in a white control group. Young white hypertensive patients (< 45 years) had higher plasma noradrenaline than controls, and in white hypertensives plasma noradrenaline was positively correlated with plasma renin.

115 factory workers (62 white, 53 black) were studied with measurements of blood pressure, plasma noradrenaline concentration, and plasma renin activity. Blood pressure was higher in blacks than in whites. There were no ethnic differences in plasma noradrenaline, which increased with age, but was not related to blood pressure. Mean plasma renin activity was 55% lower in blacks than whites and this difference was not related to differences in sodium intake. There were no associations between renin and noradrenaline, or between renin and blood pressure.