Related Experiment Video

Updated: Jun 22, 2026

Hydra, a Computer-Based Platform for Aiding Clinicians in Cardiovascular Analysis and Diagnosis
07:51

Hydra, a Computer-Based Platform for Aiding Clinicians in Cardiovascular Analysis and Diagnosis

Published on: September 26, 2018

Blood pressure variables and cardiovascular risk: new findings from ADVANCE

Andre-Pascal Kengne1, Sébastien Czernichow, Rachel Huxley

  • 1ADVANCE Collaborative Group, The George Institute for International Health, PO Box M201, Missenden Road, Sydney NSW 2050, Australia.

Hypertension (Dallas, Tex. : 1979)
|May 28, 2009
PubMed

Insights

Systolic blood pressure (SBP) and pulse pressure (PP) are key indicators for cardiovascular risk in type 2 diabetes patients. Diastolic blood pressure (DBP) is less effective, with SBP being the simplest predictor.

Area of Science:

  • Cardiology
  • Endocrinology
  • Vascular Medicine

Background:

  • Cardiovascular risk stratification in type 2 diabetes mellitus (T2DM) requires understanding the impact of various blood pressure indices.
  • Previous research has not definitively established the relative importance of different blood pressure measures on cardiovascular outcomes in T2DM.
  • The Action in Diabetes and Vascular Disease: Preterax and Diamicron-Modified Release Controlled Evaluation (ADVANCE) study provides a large cohort for this investigation.

Purpose of the Study:

  • To compare the predictive strength of baseline systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), and mean arterial pressure (MAP) for major cardiovascular events in T2DM patients.
  • To determine which blood pressure index is the most effective determinant of cardiovascular risk in this population.
  • To evaluate the utility of achieved blood pressure values versus baseline values in risk prediction.

Main Methods:

  • Analysis of 11,140 participants from the ADVANCE study with a mean follow-up of 4.3 years.
  • Statistical comparison of hazard ratios for major cardiovascular events associated with increments in SBP, DBP, PP, and MAP.
  • Receiver operating characteristic (ROC) curve analysis to compare the discriminatory ability of different blood pressure indices.
  • Assessment of risk prediction models using both baseline and achieved blood pressure measurements.

Main Results:

  • Higher hazard ratios for major cardiovascular events were associated with increments in SBP (1.17) and PP (1.20) compared to MAP (1.12) and DBP (1.04).
  • ROC curve analysis indicated slightly better discrimination for SBP and PP than MAP and DBP for major cardiovascular and coronary events.
  • Using achieved blood pressure values offered marginal improvements for SBP, DBP, and MAP, but did not significantly alter the predictive performance compared to PP.

Conclusions:

  • Systolic blood pressure (SBP) and pulse pressure (PP) are the most significant determinants of major cardiovascular outcomes in older patients with type 2 diabetes mellitus.
  • Diastolic blood pressure (DBP) demonstrated the least effectiveness in predicting cardiovascular risk in this cohort.
  • SBP emerges as the simplest and most broadly applicable predictor of cardiovascular risk across diverse age groups and populations with T2DM.

More Related Videos

Measuring the Carotid to Femoral Pulse Wave Velocity (Cf-PWV) to Evaluate Arterial Stiffness05:51

Measuring the Carotid to Femoral Pulse Wave Velocity (Cf-PWV) to Evaluate Arterial Stiffness

Published on: May 3, 2018

Related Concept Videos

Factors affecting Blood pressure01:28

Factors affecting Blood pressure

Several physiological and lifestyle factors influence blood pressure (BP). Understanding these factors is crucial as they are significant in patient education and blood pressure management.
Physiological Factors:
Hypertension and Regulation of Blood Pressure01:18

Hypertension and Regulation of Blood Pressure

Hypertension, the most common cardiovascular disease, is diagnosed through repeated measurements of elevated blood pressure. Its risks, including damage to the kidney, heart, and brain, are directly proportional to blood pressure levels. Starting from 115/75 mm Hg, the risk of cardiovascular disease doubles with each increment of 20/10 mm Hg. The diagnosis relies on blood pressure measurements, not on patient symptoms, as hypertension is often asymptomatic until end-organ damage is imminent or...
Blood Studies for Cardiovascular System I: Cardiac Biomarkers01:20

Blood Studies for Cardiovascular System I: Cardiac Biomarkers

Cardiac biomarkers are enzymes, proteins, and hormones released into the blood when cardiac cells are injured. They are powerful tools for triaging.
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
Coronary Artery Disease I: Introduction01:30

Coronary Artery Disease I: Introduction

Coronary Artery Disease (CAD): An Overview with Scientific InsightsCoronary Artery Disease (CAD), often referred to as C-A-D, is a prevalent blood vessel disorder classified under the broader category of atherosclerosis. Atherosclerosis is a pathological process characterized by the hardening and narrowing of arteries due to the accumulation of atherosclerotic plaques. These plaques are composed of cholesterol, fatty substances, inflammatory cells, calcium, and fibrin, reducing blood flow to...
Pre-Procedural Guidelines for Assessing Blood Pressure01:10

Pre-Procedural Guidelines for Assessing Blood Pressure

Accurate blood pressure assessment is crucial for diagnosing and managing various health conditions. To ensure the reliability of these measurements, healthcare professionals must adhere to standardized pre-procedural guidelines. These guidelines enhance patient safety and improve the overall quality of healthcare. The following steps are essential for obtaining accurate and consistent blood pressure readings, from using the appropriate tools to ensuring effective communication with the patient.
Hypertension III: Clinical Manifestations and Diagnostic Studies01:30

Hypertension III: Clinical Manifestations and Diagnostic Studies

Hypertension is asymptomatic and also referred to as the "silent killer" until it progresses to a severe stage or causes target organ disease. Patients may experience symptoms stemming from the strain on blood vessels and tissues in various organs or the heart's increased workload.Physical exams might show no abnormalities other than high blood pressure. Signs of vascular damage, when present, correspond to the organs supplied by the affected vessels, leading to target organ damage. For...