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Blood Pressure Variability and Risk of Heart Failure in ACCORD and the VADT
Daniel S Nuyujukian1,2, Juraj Koska2, Gideon Bahn3
1Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ daniel.nuyujukian@va.gov.
Insights
Blood pressure variability increases heart failure risk in type 2 diabetes patients. Greater variability, especially dips in blood pressure, is linked to higher heart failure incidence, suggesting new treatment strategies may be needed.
Area of Science:
- Cardiology
- Endocrinology
- Clinical Research
Background:
- Blood pressure variability (BPV) is a recognized cardiovascular disease risk factor.
- The specific relationship between BPV and heart failure (HF) risk in individuals with type 2 diabetes remains less understood.
- Type 2 diabetes is independently associated with increased cardiovascular risk, including HF.
Purpose of the Study:
- To investigate the association between blood pressure variability and the risk of developing heart failure.
- To analyze BPV in the context of type 2 diabetes within large clinical trial cohorts.
- To determine if different measures of BPV predict HF risk.
Main Methods:
- Utilized data from two large cohorts: the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial and the Veterans Affairs Diabetes Trial (VADT).
- Calculated blood pressure variability using coefficient of variation (CV) and average real variability (ARV) for systolic (SBP) and diastolic blood pressure (DBP).
- Analyzed associations between BPV measures and HF risk, adjusting for relevant clinical factors and mean blood pressure.
Main Results:
- In the ACCORD cohort, both SBP and DBP variability (CV and ARV) were significantly associated with an increased risk of HF.
- In the VADT cohort, DBP variability (ARV and CV) also showed a significant association with higher HF risk.
- In ACCORD, lower baseline blood pressure with higher variability, particularly blood pressure dips, correlated with a stepwise increase in HF risk.
Conclusions:
- Blood pressure variability is a significant predictor of heart failure risk in individuals with type 2 diabetes.
- The findings suggest that periods of low blood pressure or dips during diastole may contribute to HF development.
- These results highlight the potential importance of managing blood pressure variability, not just average blood pressure, in type 2 diabetes patients to optimize HF prevention strategies.
Objective:
Although blood pressure variability is increasingly appreciated as a risk factor for cardiovascular disease, its relationship with heart failure (HF) is less clear. We examined the relationship between blood pressure variability and risk of HF in two cohorts of type 2 diabetes participating in trials of glucose and/or other risk factor management.
Research Design And Methods:
Data were drawn from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial and the Veterans Affairs Diabetes Trial (VADT). Coefficient of variation (CV) and average real variability (ARV) were calculated for systolic (SBP) and diastolic blood pressure (DBP) along with maximum and cumulative mean SBP and DBP during both trials.
Results:
In ACCORD, CV and ARV of SBP and DBP were associated with increased risk of HF, even after adjusting for other risk factors and mean blood pressure (e.g., CV-SBP: hazard ratio [HR] 1.15, P = 0.01; CV-DBP: HR 1.18, P = 0.003). In the VADT, DBP variability was associated with increased risk of HF (ARV-DBP: HR 1.16, P = 0.001; CV-DBP: HR 1.09, P = 0.04). Further, in ACCORD, those with progressively lower baseline blood pressure demonstrated a stepwise increase in risk of HF with higher CV-SBP, ARV-SBP, and CV-DBP. Effects of blood pressure variability were related to dips, not elevations, in blood pressure.
Conclusions:
Blood pressure variability is associated with HF risk in individuals with type 2 diabetes, possibly a consequence of periods of ischemia during diastole. These results may have implications for optimizing blood pressure treatment strategies in those with type 2 diabetes.
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