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Long-Term Variability of Blood Pressure, Cardiovascular Outcomes, and Mortality: The Look AHEAD Study
Arnaud D Kaze1, Prasanna Santhanam2, Sebhat Erqou3
1Department of Medicine, University of Maryland Medical Center, Baltimore, Maryland, USA.
Insights
Greater blood pressure variability in type 2 diabetes patients is linked to increased cardiovascular risks. Higher systolic blood pressure (SBP) variability correlated with cardiovascular mortality and events, while diastolic blood pressure (DBP) variability increased overall and cardiovascular mortality.
Area of Science:
- Cardiology
- Endocrinology
- Public Health
Background:
- Type 2 diabetes is a major risk factor for cardiovascular disease (CVD).
- Visit-to-visit blood pressure (BP) variability is an emerging risk factor for adverse cardiovascular outcomes.
- The association between BP variability and CVD events in diabetic populations requires further investigation.
Purpose of the Study:
- To evaluate the association between visit-to-visit blood pressure variability and incident cardiovascular disease (CVD) and mortality in adults with type 2 diabetes.
Main Methods:
- Analysis of 4,152 participants from the Look AHEAD trial, free of CVD events at baseline.
- Assessment of systolic blood pressure (SBP) and diastolic blood pressure (DBP) variability using standard deviation, variation independent of the mean, and coefficient of variation over four annual visits.
- Utilized Cox regression to calculate adjusted hazard ratios (aHRs) for CVD events (myocardial infarction, stroke, CVD-related deaths) and all-cause mortality.
Main Results:
- Over a median of 6.6 years, 220 myocardial infarctions, 105 strokes, 62 CVD-related deaths, and 236 deaths occurred.
- Higher tertiles of SBP variability were associated with increased CVD mortality (aHR 1.98) and stroke (aHR 1.64) after adjusting for confounders.
- Higher tertiles of DBP variability were associated with increased cardiovascular mortality (aHR 1.84) and all-cause mortality (aHR 1.43).
Conclusions:
- Increased visit-to-visit SBP variability is associated with higher cardiovascular mortality and CVD events in individuals with type 2 diabetes.
- Increased visit-to-visit DBP variability is linked to elevated overall and cardiovascular mortality in this population.
- BP variability may represent a significant, independent risk factor for adverse outcomes in type 2 diabetes.
Background:
We evaluated the associations of visit-to-visit blood pressure (BP) variability with incident cardiovascular disease (CVD) and deaths in adults with type 2 diabetes.
Methods:
We analyzed 4,152 participants in Look AHEAD (Action for Health in Diabetes) free of CVD events and deaths during the first 36 months of follow-up. Variability of systolic BP (SBP) and diastolic BP (DBP) across 4 annual visits was assessed using the intraindividual SD, variation independent of the mean, and coefficient of variation. Cox regression was used to generate the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for CVD (myocardial infarction [MI], stroke, or CVD-related deaths) and mortality.
Results:
Over a median of 6.6 years, there were 220 MIs, 105 stroke cases, 62 CVD-related deaths, and 236 deaths. After adjustment for confounders including average BP, the aHRs for the highest (vs. lowest) tertile of SD of SBP were 1.98 (95% CI 1.01-3.92), 1.25 (95% CI 0.90-1.72), 1.26 (95% CI 0.96-1.64), 1.05 (95% CI 0.75-1.46), and 1.64 (95% CI 0.99-2.72) for CVD mortality, all-cause mortality, CVD, MI, and stroke, respectively. The equivalent aHRs for SD of DBP were 1.84 (95% CI 0.98-3.48), 1.43 (95% CI 1.03-1.98), 1.19 (95% CI 0.91-1.56), 1.14 (95% CI 0.82-1.58), and 0.97 (95% CI 0.58-1.60), respectively.
Conclusions:
In a large sample of individuals with type 2 diabetes, a greater variability in SBP was associated with higher cardiovascular mortality and CVD events; a higher variability in DBP was linked to increased overall and cardiovascular mortality.
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Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.