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Актуальні проблеми сучасної медицини
18
DOI 10.31718/2077–1096.23.1.18
UDC 616.12-008.331.1
Isgandar M. A.¹, Gurbanov Y. Z.¹, Huseynova N. N.², Sultanova S. S.², Mirzazade V. A.²
COMPARATIVE ANALYSIS OF THE PREVALENCE OF NORMOTENSION AND
HYPERTENSION IN DIAGNOSIS OF ARTERIAL HYPERTENSION ACCORDING
TO ESC/ESH (2018) AND ACC/AHA (2017) DIAGNOSIS IN PEOPLE WITH
NORMAL GLUCOSE METABOLISM, PREDIABETES AND TYPE 2 DIABETES
¹Azerbaijan Medical University, Baku, Azerbaijan
²Azerbaijan State Advanced Training Institute for Doctors named after A.A. Aliyev, Baku, Azerbaijan
The comorbidity between hypertension with diabetes leads to an increase in the risk of death and
cardiovascular events by 44% and 41%, respectively, compared with 7% and 9% risks in people suffering
only from diabetes and having no hypertension. Purpose. To determine the effect of the criteria for the
diagnosis of hypertension proposed by ACC/AHA (2017) and ESC/ESH (2018) on the detection of this
disease in people with normal carbohydrate metabolism, prediabetes and type 2 diabetes mellitus. Materials
and methods. A retrospective analysis of the database of the Azerbaijan Association of Endocrinology,
Diabetology and Therapeutic Training was carried out. The data of 596 examined patients were analyzed,
then three main groups were formed: a group with normal carbohydrate metabolism (n=99), a group with
prediabetes (n=47), a group with type 2 diabetes mellitus (n = 450). The patients included in the study were
divided into 2 samples: those, who have DM2; those, who have no DM2. Including the patients in the group
of with DM2 was based medical history data about the presence of DM2 and / or taking hypoglycemic drugs.
Results. When applying the ACC/AHA criteria (2017), normotension (systolic blood pressure <130 mmHg
and diastolic blood pressure <80 mmHg) occurred in 40.4% (95% CI 30.69%; 50.12) of the control group,
while 59.6% (95% CI 49.88; 69.31) there was arterial hypertension. 14.9% of the prediabetes group (95% CI
4.60%; 25.18)% had normotension according to the same criteria, while the majority of the participants in this
group – 85.1 (95% CI 74.82; 95.40)% had arterial hypertension. In the type 2 diabetes mellitus group,
normotension was found in 15.8 (95% CI 12.41%; 19.15)%, and arterial hypertension – in 84.2 (95% CI
80.85; 87.59)%. Thus, arterial hypertension was statistically significantly less common in the control group
than in prediabetes (p <0.01) and type 2 diabetes mellitus (p <0.001). Conclusion. Thus, in people with
normal carbohydrate metabolism, prediabetes and type 2 diabetes mellitus, the use of ACC/AHA diagnostic
criteria (2017) led to a statistically significantly higher incidence of hypertension than when using the criteria
for the diagnosis of hypertension according to ESC/ESH (2018).
Key words: Arterial hypertension, normal carbohydrate metabolism, prediabetes, type 2 diabetes.
Introduction
Arterial hypertension (AH) is the leading cause
of death worldwide, resulting in 10.4 million deaths
per year [1]. The total number of patients with hy-
pertension in 2010 was 1.39 billion people [2]. At
the same time, only 349 million people suffering
from hypertension live in high-income countries and
1.04 billion people with this disease live in the rest
of the world [2], including our country [3].
The number of patients with diabetes mellitus
(DM) globally has increased from 151 million in
2000 to 537 million in 2021 and is expected to
reach 783 million in 2045 [4]. About 90% of DM pa-
tients are individuals with type 2 diabetes (DM2) [5].
The comorbidity between hypertension and diabe-
tes leads to an increase in the risk of death and
cardiovascular events by 44% and 41%, respec-
tively, compared with 7% and 9% risks in people
suffering only from diabetes and having no hyper-
tension [6].
The comorbidity between prediabetes (PD) with
hypertension also increases the risk of cardiovascu-
lar diseases [7, 8]. However, the role of hyperten-
sion, the frequency of its occurrence and the sig-
nificance as a comorbid condition in PD has not
been sufficiently studied and represents a field for
research of both clinicians and researchers.
The issue of the diagnosis of hypertension still
cannot be considered as definitively resolved. Cur-
rently, there are two main documents in the world
that define the approach to the diagnosis of hyper-
tension. The 2017 recommendations of the Ameri-
can College of Cardiology/American Heart Associa-
tion (ACC/AHA, 2017) were prepared by a group of
American medical organizations [9], and the 2018
recommendations of the European Society of Car-
diology/European Society of Hypertension
(ESC/ESH, 2018) were prepared by European
medical societies [10]. Our country has traditionally
adhered to the European recommendations, that is,
the ESC/ESH recommendations [10]. However,
traditions, for all their undoubted importance, can-
not be considered strict scientific proof.
Purpose. To determine the effect of the criteria
for the diagnosis of hypertension proposed by
ACC/AHA (2017) and ESC/ESH (2018) on the de-
tection of this disease in people with normal carbo-
hydrate metabolism, prediabetes and type 2 diabe-
tes mellitus.
Materials and methods
A retrospective analysis of the database of the
Azerbaijan Association of Endocrinology, Diabetol-
ogy and Therapeutic Training, created on the basis
of outpatient records of the endocrinologists who
first applied to the team participating in the creation
of this archive, was carried out.
Актуальні проблеми сучасної медицини
Том 23, Випуск 1 (81)
19
The criteria for inclusion in the study assumed
the following data in the outpatient records: sur-
name and name of the attending physician; date of
initial examination; sex of the patient; age of the pa-
tient; height; body weight; blood pressure values
(BP); information about the presence of diabetes
and / or taking hypoglycemic drugs in the anamne-
sis; glycohemoglobin (A1c); fasting glycaemia; lipi-
dograms (total cholesterol (TH), high-density lipo-
protein cholesterol (HDL), low-density lipoprotein
cholesterol (LDL), triglycerides (TG), as well as the
glomerular filtration rate (GFR) of 60 ml/min/1.73
m2 or more.
The criteria for exclusion from the study are: the
presence of type 1 diabetes mellitus or other (spe-
cific) types of diabetes; pregnancy; pronounced in-
dependent or comorbid endocrine pathology, which
can significantly affect both the level of A1c and
other indicators of metabolism and blood pressure;
pronounced comorbid pathology on the part of in-
ternal organs, which can significantly affect the
state of carbohydrate metabolism, and on the BP
values.
Initially, the participants included in the study
were divided into 2 groups:
– patients having DM 2;
– patients having no DM2.
Distributing the patients between the groups of
patients with DM2 was based on medical history
data about the diagnosis of DM2 and / or taking hy-
poglycaemic drugs. In case of having no DM 2 di-
agnosis, the criterion for inclusion in group C 2 was
the presence of at least two of the given diagnostic
indicators [11, 12, 13, 14]:
– A1 level with 6.5% (48 mmol/mol) and above;
– fasting venous plasma glycemia 126 mg/dl
(7.0 mmol/L) and higher;
– glycemia in venous plasma 2 hours after a
load of 75.0 g of glucose 200 mg/dl (11.1 mmol/L)
and higher.
The group of people with normal carbohydrate
metabolism (NCM) included those who met all three
of the following criteria [15]:
1. A1c level was 5.6% (38 mmol/mol) and lower;
2. fasting glycemia in venous plasma less than
110 mg/dl (6.1 mmol/L);
3. glycemia 2 hours after loading 75.0 g of glu-
cose less than 140 mg / dl (7.8 mmol/l).
In the future, the group with NCM will be desig-
nated as a control group (CG).
The rest of the study participants, whose state of
carbohydrate metabolism did not meet both the cri-
teria of DM and the criteria of normal carbohydrate
metabolism, made up the PD group.
In the course of statistical analysis, the value of
the fractions (%) was determined. The confidence
interval of the fractions was determined for a 95%
probability using the Wilson method using an online
calculator [16]. The significance of the differences
between the fractions was calculated using the
method χ2 [17].
Results and discussion
Table 1 presents data on the comparative
analysis of the occurrence rate in CG, PD and DM2
normotension and hypertension according to
ACC/AHA criteria (2017) [1].
Table 1
Occurrence rate in CG, with PD and with DM2
normotension and hypertension according to ACC/AHA criteria (2017)
Condition AH
№ Group Indicator Normotension AH
% 40.4 59.6
1 CG (n=99) 95% СI 30.69; 50.12 49.88; 69.31
% 14.9 85.1
2 PD (n=47) 95% СI 4.60; 25.18 74.82; 95; 40
% 15.8 84.2
3 DM 2 (n = 450) 95% СI 12.41; 19.15 80.85; 87.59
Statistical significance of differences in frequency of occurrence between groups (p)
р 1-2 < 0.01
р 1-3 < 0.001
р 2-3 > 0.05
Table 1 shows that when applying the ACC/AHA
criteria (2017) [9], normotension (systolic blood
pressure (SBP) <130 mmHg and diastolic blood
pressure (DBP) <80 mmHg) occurred in 40.4%
(95% CI 30.69%; 50.12) representatives of CG,
whereas 59.6% (95% CI 49.88; 69.31) had hyper-
tension. 14.9% of the PD group (95% CI 4.60%;
25.18)% had normotension according to the same
criteria [9], whereas the majority of the participants
in this group, 85.1 individuals (95% CI 74.82;
95.40), % had hypertension.
In the DM2 group, according to the ACC/AHA
criteria (2017) [9], normotension was present in
15.8 (95% CI 12.41%; 19.15) %, and hypertension
in 84.2 (95% CI 80.85; 87.59) %. Thus, hyperten-
sion was statistically significantly less common in
CG than in P (p <0.01) and DM2 (p <0.001). The
frequency of normotension and hypertension in PD
and DM2 did not differ statistically significantly (p
>0.05).
Table 2 presents data on a comparative analysis
of the frequency of occurrence in CG, PD and DM2
normotension and hypertension according to
ESC/ESH criteria (2018) [10].
Актуальні проблеми сучасної медицини
20
Table 2
Occurrence rate in CG with PD and with DM2 normotension and hypertension according to ESC/ESH criteria (2018)
Condition AH
№ Group Indicator Normotension AH
% 67.7 32.3
1 CG(n=99) 95% СI 58.42; 76.94 23.06; 41.58
% 34.0 66.0
2 PD (n=47) 95% СI 20.35; 47.74 52.26; 79;65
% 43.6 56.4
3 DM 2 (n = 450) 95% СI 38.97; 48.14 48.14; 61.03
Statistical significance of differences in the occurrence rate between groups (p)
р 1-2 < 0.001
р 1-3 < 0.001
р 2-3 > 0.05
Table 3
The incidence of hypertension in patients with DM2 in the diagnosis of hypertension according to ACC/AHA criteria (2017) [9] and ac-
cording to ESH/ESH criteria (2018) [10]
Patients with AH
Group Diagnostic criteria % 95%CI
ESC/ESH 32.3 23.06; 41.58
ACC/AHA 59.6 49.88; 69.31
CG (n=99)
P < 0.001
ESC/ESH 66.0 52.26; 79.65
ACC/AHA 85.1 74.82; 95.40
PD (n=47)
P < 0.05
ESC/ESH 56.4 51.86; 61.03
ACC/AHA 84.2 80.85; 87.59
DM 2
(n=450) P < 0.001
Table 2 demonstrates, when applying the
ESC/ESH criteria (2018) [10], normotension (SAD
<140 mmHg and DAD <90 mmHg) occurred in
67.7% (95% CI 58.42%; 76.94) of the control group,
whereas 32.3% (95% CI 23.06; 41.58) had AH. In
the PD group, normotension according to the
ESC/ESH criteria (2018) [10] occurred in 34.0%
(95% CI 20.35%; 47.74) of the surveyed, while the
majority of the participants in the PD group, 66.0%
(95% CI 52.26; 79.65) had hypertension. With DM2,
43.6 (95% CI 38.97%; 48.14) had normotension
according to ESH/ESH criteria (2018) [10], and
56.4% (95% CI 48.14; 61.03) % had hypertension.
AH was statistically significantly less common in
CG than in P (p=0.001) and C2 (p<0.001). The in-
cidence of hypertension in PD and DM2 did not dif-
fer statistically significantly (p> 0.05).
Table 3 presents data on the occurrence rate of
AH and normotension in the examined patients,
people with PD and patients with DM2 in the diag-
nosis of AH according to the ACC/AHA criteria
(2017) [9] and according to the ESC/ESH criteria
(2018) [10].
Table 3 indicates that in CG, the occurrence rate
of AH in its diagnosis according to the ACC/AHA
criteria (2017) [9] was significantly (p<0.001) higher
than the occurrence rate of AH when using the
ESC/ESH diagnostic criteria (2018) [10]: 32.3 (95%
CI 23.06; 41.58) % vs. 59.6 (95%CI 49.88; 69.31)
%. A similar situation was in the PD group. The oc-
currence rate of AH in its diagnosis according to the
ACC/AHA criteria (2017) [9] was significantly (p
<0.05) higher than the frequency of occurrence of
AH when using the ESC/ESH diagnostic criteria
(2018) [10]: 66.0 (95% CI 52.26; 79.65) % vs. 85.1
(95%CI 74.82; 95.40) %. In the DM2 group, the in-
cidence of AH in its diagnosis according to the
ACC/AHA criteria (2017) [9] was significantly (p
<0.001) higher than the incidence of AH when us-
ing the ESC/ESH diagnostic criteria (2018) [10]:
84.2 (95% CI 80.85; 87.59) % vs. 56.4 (95%CI
51.86; 61.03) %.
Conclusion. Thus, in people with NCM, PD and
DM2, the application of the ACC/AHA diagnostic
criteria (2017) led to a statistically significantly
higher incidence of AH than when using the
ESC/ESH diagnostic criteria (2018).
Prospects for further research
The development of criteria used for the diagno-
sis of "Arterial hypertension" should be thoroughly
considered before the beginning of pharmacother-
apy. The state of carbohydrate metabolism (the
presence of Prediabetes, type 2 diabetes mellitus
or their absence) should be taken into account
when deciding which criteria for the diagnosis of
"Arterial hypertension" should be applied.
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Реферат
ПОРІВНЯЛЬНИЙ АНАЛІЗ ЗУСТРІЧАЄМОСТІ НОРМОТЕНЗІЇ ТА ГІПЕРТЕНЗІЇ ПРИ ДІАГНОСТИЦІ АРТЕРІАЛЬНОЇ ГІПЕРТЕНЗІЇ
У ВІДПОВІДНОСТІ З КРИТЕРІЯМИ ESC/ESH (2018) І КРИТЕРІЯМИ ACC/AHA (2017) У ЛЮДЕЙ З НОРМАЛЬНИМ ОБМІНОМ
ГЛЮКОЗИ, ПРЕДІАБЕТОМ І ЦУКРОВИМ ДІАБЕТОМ 2 ТИПУ
Іскендер М. А., Гурбанов Я. З., Гусейнова Н. Н., Султанова С.С., Мірзазаде В. А.
Ключові слова: артеріальна гіпертензія, нормальний вуглеводний обмін, предіабет, цукровий діабет 2 типу.
Мета. Визначення впливу критеріїв діагностики артеріальної гіпертензії, пропонованих ACC/AHA
(2017) та ESC/ESH (2018) на виявлення цього захворювання у людей з нормальним вуглеводним об-
міном, предіабетом та цукровим діабетом типу 2. Матеріали та методи. Проведено ретроспективний
аналіз бази даних Азербайджанської Асоціації Ендокринології, Діабетології та Терапевтичного На-
вчання. Проаналізовано дані 596 обстежених, з яких були сформовані три основні групи: група з нор-
мальним вуглеводним обміном (n=99), група з предіабетом (n=47), група з цукровим діабетом типу 2
(n=450). Був проведений розподіл хворих, включених у популяцію, на 2 вибірки: обстежені з наявним
цукровим діабетом 2 типу; обстежені без цукрового діабету 2 типу. Підставою для включення пацієнта
до групи хворих з цукровим діабетом 2 типу була анамнестична інформація про наявність цукрового
діабету 2 типу та/або прийом цукрознижувальних препаратів. Результати. При застосуванні критеріїв
ACC/AHA (2017) нормотензія (систолічний артеріальний тиск <130 мм рт.ст. та діастолічний артеріа-
льний тиск <80 мм рт.ст.) мала місце у 40.4% (95% CI 30.69%; 50.12) представників контрольної групи,
тоді як у 59.6% (95% CI 49.88; 69.31) була артеріальна гіпертензія. У 14.9% групи предіабету (95% CI
4.60%; 25.18) % відповідно до тих же критеріїв мала місце нормотензія, тоді як у більшої частини уча-
сників цієї групи - 85.1 (95% CI 74.82; 95.40) % - була артеріальна гіпертензія. В групі пацієнтів з цук-
ровим діабетом 2 типу нормотензія була у 15.8 (95% CI 12.41%; 19.15) %, а артеріальна гіпертензія – у
84.2 (95% CI 80.85; 87.59) %. Тобто, артеріальна гіпертензія статистично значно рідше зустрічалася в
контрольній групі, ніж при предіабеті (р <0.01) і цукровому діабеті 2 типу (р <0.001). Висновки. Встано-
влено, що у людей з нормальним вуглеводним обміном, при предіабеті та цукровому діабеті 2 типу
застосування критеріїв діагностики ACC/AHA (2017) призводило до статистично значуще більшої час-
тоти зустрічаємості артеріальної гіпертензії, ніж при застосуванні критеріїв діагностики артеріальної гі-
пертензії за ESC/ESH (2018).