Visit-to-visit variability in blood pressure strongly predicts all-cause mortality in patients with type 2 diabetes: A 5·5-year prospective analysis
Journal
European Journal of Clinical Investigation
Journal Volume
42
Journal Issue
3
Date Issued
2012-03-01
Author(s)
Abstract
Background Elevations in blood pressure and visit-to-visit variability have been found to significantly increase the risk of cardiovascular morbidity and mortality in nondiabetic individuals. This study has assessed the association between all-cause mortality and blood pressure parameters [systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), mean arterial pressure (MAP) and visit-to-visit variability] in patients with type 2 diabetes. Materials and methods A longitudinal cohort study of 2161 patients with type 2 diabetes and a mean follow-up period of 66·7±7·5months. Using Cox regression models, blood pressure parameters were related to the risk of all-cause mortality. Results Visit-to-visit variability in SBP [HR: 1·048 (95% CI: 1·005-1·092; P=0·03)], DBP [HR: 1·090 (95% CI: 1·021-1·163; P=0·01)] and MAP [HR: 1·099 (95% CI: 1·033-1·170; P=0·003)] significantly predicted all-cause mortality in patients with type 2 diabetes after adjusting for baseline data, mean follow-up blood pressure profiles and HbA1c. Visit-to-visit variability in PP [HR: 1·139 (95% CI: 1·030-1·258; P=0·01)] significantly predicted cardiovascular mortality. Neither baseline nor follow-up SBP, DBP, PP nor MAP was significantly associated with all-cause and cardiovascular mortality after adjusting for blood pressure variability. The risk of all-cause mortality with a mean follow-up SBP has a U-shaped distribution. Patients with a mean follow-up DBP>90mmHg were at higher risk of mortality than those with DBP < 90mmHg. Conclusions Visit-to-visit variability in blood pressure was significantly associated with all-cause mortality independent of mean BP in patients with type 2 diabetes. The data for blood pressure variability might be regarded as a potentially important therapeutic target in the management of type 2 diabetes. © 2011 The Authors. European Journal of Clinical Investigation © 2011 Stichting European Society for Clinical Investigation Journal Foundation.
Subjects
Blood pressure variability | Diabetes | Hypertension | Mortality | Taiwanese
SDGs
Type
journal article