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. 1. Introduction Persons living with diabetes have a prevalence of systemic hypertension twice as high as persons without diabetes [1–5]. Hypertension is an important problem in persons living with diabetes because it is strongly associated with the development of the major complications of diabetes—retinopathy, nephropathy, and cardiovascular disease [6–10]. As such, it is a major cause of morbidity and mortality among persons living with diabetes [11, 12]. Hypertension in persons living with diabetes appears to be more common in African-Americans than in whites [5]. For instance, data from the 1976–1980 National Health and Nutrition Examination Survey for mostly type 2 diabetic persons indicate that both systolic and diastolic blood pressures are higher in African Americans compared with whites at ages <54 years [5]. In persons living with diabetes, reducing morbidity and mortality from hypertension is predicated on identifying risk factors associated with the development of hypertension, so that treatment strategies may be implemented. In whites living with type 1 diabetes, medical risk factors reported in association with the development of
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