Type 2 diabetes mellitus (DM) and hypertension have emerged as major health problems in Saudi Arabia. The prevalence of hypertension in Saudi Arabia has been reported by Ahmed et al1 to be 15% while that reported for diabetes mellitus is 7%.2 Recent studies have reported that impaired fasting blood glucose is an independent risk factor for hypertension3 and high normal blood pressure and hypertension increases the risk of developing type 2 DM.4-6 Hypertension is a common problem in diabetic patients.7,8 It is a well-known risk factor for coronary heart disease in diabetics as well as non-diabetics.9 It’s prevalence in type 2 DM varies from 39%10 to 42%.11 The aim of this study is to report on the prevalence and implications of hypertension in hospitalized type 2 diabetics at King Abdulaziz University Hospital.

Methods. King Abdulaziz University Hospital (KAUH) is a teaching hospital in the western province of Saudi Arabia. The data for analysis was retrieved from the medical charts of diabetic patients admitted to the medical unit of KAUH in the period between January 1998 and September 1999. The criteria for inclusion in the study was type 2 DM according to the World Health Organization (WHO) criteria,12 both hypertensive and normotensive (with no evidence of any other cause of secondary hypertension). Hypertension was defined as systolic blood pressure more than 140 mmHg and diastolic more than 90 mmHg. The following data was collected: patients’ age, sex, body mass index (BMI) (weight in kilogram divided by square height in meters). Degree of glycemic control was measured by glycosylated hemoglobin (HbA1c). Poor glycemic control was defined as HbA1c >7%. The presence of hyperlipidemia {defined as total serum cholesterol >5.2 mmol/l, low density lipoprotein (LDL) > 2.6 mmol/l, triglyceride >1.7 mmol/l}, impaired renal function (raised serum creatinine after exclusion of other causes of renal failure), history of smoking, family history of hypertension, admissions due to ischemic heart disease (myocardial infarction, unstable angina), cerebrovascular accident (CVA), duration of hospital stay and outcome were recorded. Statistical analysis was performed using the SPSS 7.5 (Statistical Package for Social Science) software.

Results. A total of 427 patients were included in the study with a mean age of 57.93+/-13.51 years, male:female ratio of 249:178 (1.4:1) and mean BMI of 25.46+/-4.56 Kg/m2. One hundred and ninety five patients (46%) were hypertensive. As shown in Table 1 there is a significant difference between hypertensive and normotensive diabetics for age, BMI, family history of hypertension, presence of hyperlipidemia, development of cardiovascular complications and renal failure, duration of hospital stay and mortality while no significant difference was found for sex, poor glycemic control or the development of cerebrovascular accident.

Discussion. Hypertension is a multifactorial disorder and results from contributions from both genetic and environmental causes. It concentrates in families but does not follow any clear-cut Mendelian Pedigree pattern of inheritance.13 This is also applied for hypertensive diabetics in whom we found a strong family history of hypertension. In addition to the development of diabetic nephropathy, at least 2 other factors have been proposed to contribute to hypertension in diabetes: hyperinsulinemia and extracellular fluid volume expansion.7,8 The prevalence of hypertension in type 2 DM was 46%, which is more than had been previously reported.10,11 Our study showed that hypertensive diabetics were ol

Received 24th July 2000. Accepted for publication in final form 20th September 2000.

22. UK Prospective Diabetes Study Group: Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes (UKPDS 38) BMJ 1998; 317:<