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Long-term blood pressure variability, incidence of hypertension and changes in renal function in type 2 diabetes

Francesca Viazzi1, Elisa Russo1, Antonio Mirijello2

  • 1University of Genoa and IRCCS Ospedale Policlinico San Martino, Genova.

Journal of Hypertension
|July 11, 2020
PubMed

Insights

High blood pressure variability predicts new hypertension and worsening kidney function in type 2 diabetes patients. This visit-to-visit systolic blood pressure variability is a key risk factor for developing hypertension and albuminuria.

Area of Science:

  • Cardiology
  • Nephrology
  • Endocrinology

Background:

  • Long-term visit-to-visit systolic blood pressure variability (VVV) is a known predictor of cardiovascular and renal events in hypertensive patients.
  • The predictive role of VVV for the development of hypertension and chronic kidney disease remains unclear.

Purpose of the Study:

  • To investigate the association between VVV and the incidence of hypertension.
  • To assess the impact of VVV on renal function changes in patients with type 2 diabetes and normal blood pressure.

Main Methods:

  • Analysis of clinical records from 8998 patients with type 2 diabetes, normal blood pressure, and normal estimated glomerular filtration rate (eGFR).
  • VVV was calculated as the standard deviation of mean systolic blood pressure (SBP) over at least four visits within two consecutive years.
  • Hypertension and renal function changes (worsening albuminuria, eGFR decrease) were defined based on established clinical criteria.

Main Results:

  • An increase of 5 mmHg in VVV was independently associated with a 19% increased risk of developing hypertension and a 5% increased risk of worsening albuminuria.
  • Patients in the highest quartile of VVV (>12.8 mmHg) had a 50% higher risk of developing hypertension and a 20% higher risk of worsening albuminuria compared to those in the lowest quartile (<6.9 mmHg).
  • No significant association was found between VVV and a decrease in eGFR.

Conclusions:

  • Elevated visit-to-visit systolic blood pressure variability is an independent predictor of incident hypertension in individuals with type 2 diabetes and normal baseline blood pressure.
  • Increased VVV is also associated with an increased risk of worsening albuminuria, indicating a potential role in early kidney damage progression.
Abstract

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