Relationship of Hypertension with CVD Mortality Varies by CVD Type but Not Race in Persons with Diabetes

Introduction and Objective: Diabetes and hypertension are increased among African Americans as is the risk of cardiovascular disease (CVD) mortality, though this may vary by type of CVD. We investigated the relationship between hypertension and CVD mortality outcomes, namely coronary heart disease (CHD), heart failure and stroke among persons w/ diabetes and whether risk varied by race for type of CVD mortality. Methods: We conducted a mortality follow up of a cohort of 16,553 mostly low income predominately African American and White participants aged 40-79 w/ diabetes (African American n=11,335; White American n=4,518, Other races n=700) at cohort entry. Multivariable competing risk Cox analyses were conducted to obtain Hazard Ratios with 95% CI for CVD mortality outcomes and all other mortality. Results: Mean age and diabetes duration were 55 and 10 years, respectively. After a mean of 13.4 years of followup, there were 8661 deaths (53% of the population). In multivariable adjusted analysis, HRs (95% CIs) for hypertension were: CHD mortality (HR = 1.24 95% CI = 1.07 - 1.42), heart failure mortality (HR = 1.39 95% CI =1.17 - 1.65), stroke mortality (HR = 1.43 95% CI = 1.16 - 1.75), and All Other Mortality (HR = 1.20 95% CI = 1.11 - 1.30) compared to participants without hypertension. African Americans (HR=0.67, 0.60-0.75) and other races (0.83, 0.65-1.06) were at a lower risk of CHD, an increased risk of stroke mortality (African Americans HR: 1.35, 1.12-1.62; other races: 1.27, 0.86-1.89) and no increased risk of heart failure mortality (African Americans: HR=0.98, 0.86-1.12: Other races: HR=1.09: 0.82-1.44) compared to non-Hispanic White American participants, however, the association of hypertension with each of the CVD mortality outcomes did not vary by race (p-interaction all>0.10). Conclusion: Although the relationship of race with risk of CVD mortality varied by type of CVD, the relationship of hypertension with these mortality outcomes did not vary by race. Our data suggests that hypertension affects CVD mortality outcomes similarly across races. Disclosure: R. Chauma: None. R. Conway: None. Funding: National Institutes of Health (U01CA202979) and Vanderbilt-Ingram Cancer Center (P30 CA68485).