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Second home blood pressure measurements per occasion predict incident cardiovascular events in type 2 diabetes:
Madoka Sumi1, Emi Ushigome2, Nobuko Kitagawa1
1Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan.
Insights
For type 2 diabetes patients, taking two morning home blood pressure (HBP) measurements per occasion is sufficient for predicting cardiovascular events. This approach offers similar prognostic value to taking three measurements, simplifying monitoring protocols.
Area of Science:
- Cardiology
- Endocrinology
- Public Health
Background:
- Home blood pressure (HBP) monitoring is a superior predictor of cardiovascular events compared to clinical monitoring.
- Guidelines vary on the optimal number of HBP measurements per occasion, creating uncertainty in clinical practice.
- Predicting cardiovascular events in patients with type 2 diabetes requires refined HBP monitoring strategies.
Purpose of the Study:
- To determine the optimal number of morning home blood pressure (HBP) measurements for predicting new cardiovascular events in type 2 diabetes patients.
- To compare the prognostic value of the 1st, 2nd, and 3rd morning HBP measurements for cardiovascular outcomes.
Main Methods:
- Retrospective cohort study of 1082 type 2 diabetes patients without prior macrovascular complications.
- HBP measured thrice daily for 14 days; average values for 1st, 2nd, and 3rd measurements calculated.
- Cox proportional hazards models and ROC curve analysis used to assess associations with cardiovascular events over 7 years.
Main Results:
- The 2nd and 3rd average morning home systolic blood pressure (MHSBP) measurements were significantly associated with increased cardiovascular event risk (HRs > 1.129).
- The area under the ROC curve (AUC) for the 2nd, 1st/2nd, and 2nd/3rd MHSBP averages was significantly higher than for the 1st MHSBP average.
- No significant difference in AUC was found between the 2nd/3rd and 1st/2nd/3rd MHSBP averages compared to the 1st/2nd average.
Conclusions:
- Taking two morning home blood pressure measurements per occasion is sufficient for predicting cardiovascular events in type 2 diabetes patients.
- This simplified approach provides comparable prognostic accuracy to using three measurements, potentially improving adherence and reducing patient burden.
- The findings suggest a refinement in HBP monitoring recommendations for type 2 diabetes management.
Abstract:
Home blood pressure (HBP) monitoring is a better prognostic predictor than clinical BP monitoring. However, the suggested number of HBP measurements in each occasion varies across guidelines. The study aimed to identify which HBP measurements in each occasion are more closely associated with new cardiovascular events in patients with type 2 diabetes. This retrospective cohort study included 1082 patients with type 2 diabetes without a history of macrovascular complications. HBP was measured three times each morning and evening for 14 days, and the average value over the 14 days was calculated. During a median follow-up of 7.0 years, 117 patients (11.1%) had cardiovascular events. The Cox proportional hazards model was used to examine the association between the average morning home systolic BP (MHSBP) for the 1st, 2nd, and 3rd measurements and cardiovascular events. The adjusted hazard ratios (HR) (95% confidence interval) for the onset of cardiovascular events in the 2nd and 3rd mean MHSBP were 1.129 (1.008-1.265) and 1.135 (1.010-1.275), respectively. The area under the receiver-operating characteristic curve (AUC) for the 2nd, 1st/2nd, 2nd/3rd, and 1st/2nd/3rd mean MHSBP was significantly greater than that of the 1st mean MHSBP (p = 0.040, p = 0.014, p = 0.020, and p = 0.021, respectively). No significant difference was observed between the AUC of the 2nd/3rd and 1st/2nd/3rd mean MHSBP and that of the 1st/2nd mean MHSBP. We recommend that HBP measurements be taken just twice per occasion to predict cardiovascular events in patients with type 2 diabetes.
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