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Effects of visit-to-visit variability in systolic blood pressure on macrovascular and microvascular complications in
Jun Hata1, Hisatomi Arima, Peter M Rothwell
1From The George Institute for Global Health, University of Sydney, Sydney, Australia (J.H., H.A., M.W., S.Z., C.A., A.P., B.N., S.M., J.C.); University of Oxford, Oxford, United Kingdom (P.M.R., S.M.); School of Public Health, Monash University, Clayton, Australia (S.Z.); Bond University, Gold Coast, Australia (P.G.); Université de Montréal, Montreal, Canada (P.H.); University of Milan-Bicocca, Milan, Italy (G.M.); Imperial College, London, United Kingdom (N.P.); and University College London (UCL) and the National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, United Kingdom (B.W.).
Systolic blood pressure variability and maximum SBP are independent risk factors for macrovascular and microvascular complications in type 2 diabetes. These findings highlight the importance of monitoring blood pressure fluctuations in diabetic patients.
Area of Science:
- Cardiology
- Endocrinology
- Clinical Research
Background:
- Recent evidence links visit-to-visit variability in systolic blood pressure (SBP) and maximum SBP to cardiovascular disease.
- The predictive role of these SBP parameters for macrovascular and microvascular complications in type 2 diabetes mellitus (T2DM) remains unclear.
Purpose of the Study:
- To investigate whether SBP variability and maximum SBP predict macrovascular and microvascular complications in patients with T2DM.
Main Methods:
- Analysis of 8811 patients from the ADVANCE trial (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation).
- Patients were free of major macrovascular and microvascular events or death in the first 24 months.
- SBP variability (standard deviation) and maximum SBP were assessed during the first 24 months; follow-up averaged 2.4 years.
Main Results:
- 407 major macrovascular events and 476 microvascular events were recorded during follow-up.
- SBP variability was a continuous risk factor for both macrovascular and microvascular events, independent of mean SBP (P<0.05 for trend).
- Highest SBP variability was associated with increased risk: HR 1.54 (macrovascular) and 1.84 (microvascular). Highest maximum SBP was associated with HR 3.64 (macrovascular) and 2.18 (microvascular).
Conclusions:
- Visit-to-visit SBP variability is an independent risk factor for macrovascular complications in T2DM.
- Maximum SBP is an independent risk factor for both macrovascular and microvascular complications in T2DM.
- Monitoring SBP variability and maximum SBP may aid in risk stratification for diabetic patients.
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