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International Journal of Hypertension
Volume 2011 (2011), Article ID 856067, 10 pages
http://dx.doi.org/10.4061/2011/856067
Clinical Study

Medical and Psychological Risk Factors for Incident Hypertension in Type 1 Diabetic African-Americans

1Department of Ophthalmology, University of Medicine and Dentistry, New Jersey Medical School, Institute of Ophthalmology and Visual Science, 90 Bergen Street, Room 6164, Newark, NJ 07101-1709, USA
2Department of Epidemiology and Health Promotion, College of Dentistry, New York University, 380 Second Avenue Suite 301, New York, NY 10010, USA
3Psychiatry Service, New Jersey VA Health Care System, 385 Tremont Avenue, East Orange, NJ 07018, USA

Received 1 December 2010; Revised 13 May 2011; Accepted 26 May 2011

Academic Editor: Zafar Israili

Copyright © 2011 Monique S. Roy et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective. To determine risk factors for the development of hypertension among African-Americans living with type 1 diabetes. Methods. African-Americans with type 1 diabetes (n = 483) participated in a 6-year followup. At both baseline and followup blood pressure was measured twice in both sitting and standing positions using a standard protocol. Patients had a structured clinical interview, ocular examination, retinal photographs, and blood and urine assays and completed the Hostility and Direction of Hostility Questionnaire (HDHQ) and the Beck Depression Inventory (BDI). Results. Of the 280 diabetic patients with no hypertension at baseline, 82 (29.3%) subsequently developed hypertension over the 6-year followup. Baseline older age, longer duration of diabetes, family history of hypertension, greater mean arterial blood pressure, overt proteinuria, increasing retinopathy severity, peripheral neuropathy, smoking, and higher hostility scores were significantly associated with the development of hypertension. Multivariate analyses showed that higher hostility scores and overt proteinuria were significantly and independently associated with the development of hypertension in this population. Conclusions. The development of hypertension in African-Americans living with type 1 diabetes appears to be multifactorial and includes both medical (overt proteinuria) as well as psychological (high hostility) risk factors.