Blood Pressure Variability and Risk of Heart Failure in ACCORD and the VADT

Nuyujukian, Daniel S.; Koska, Juraj; Bahn, Gideon; Reaven, Peter D.; Zhou, Jin

doi:10.2337/dc19-2540

Cited by 30 publications

(30 citation statements)

References 30 publications

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“…[4][5][6][7][8][9][10][11][12] Our observations of a positive association between BP variability and risk of HF are consistent with the few studies conducted so far, although individuals without Type 2 diabetes were included in some of these reports. 5,12 Contrary to the extant studies, our study includes a variety of measures of BP variability, as well as a diverse multi-ethnic/racial sample of participants. 5 There are causal pathways that could explain the positive relation between long-term variability in BP and risk of HF in Type 2 diabetes.…”

Section: Discussionsupporting

confidence: 90%

Long‐term variability of blood pressure and incidence of heart failure among individuals with Type 2 diabetes

Kazé

Santhanam²,

Erqou

et al. 2021

ESC Heart Failure

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Aims Data on the association of long-term variability of blood pressure (BP) with incident heart failure (HF) in individuals with Type 2 diabetes are scarce. We evaluated this association in a large community-based sample of adults with Type 2 diabetes. Methods and results A total of 4200 participants with Type 2 diabetes who had available BP measurements at four visits (baseline and 12, 24, and 36 months) in the Look AHEAD (Action for Health in Diabetes) study were included. Variability of systolic BP (SBP) and diastolic BP (DBP) across the four visits was assessed using four metrics. Participants free of HF during the first 36 months were followed for HF events. Cox regression was used to generate hazard ratios (HRs) and 95% confidence intervals (CIs) for HF. Of the 4200 participants, the average age was 59 years [standard deviation (SD): 6.8]; 58.5% were women. Over a median follow-up of 6.7 years, 129 developed HF events. After adjusting for relevant confounders, the HR of incident HF for the highest vs. lowest quartile of SD of SBP was 1.77 (95% CI 1.01-3.09); the HR for the highest (vs. lowest) quartile of variability independent of the mean of SBP was 1.29 (95% CI 0.78-2.14). The adjusted HR for participants in the highest (compared with the lowest) quartile of SD of DBP was 1.61 (95% CI 1.01-2.59), and the adjusted HR for variability independent of the mean of DBP was 1.65 (95% CI 1.03-2.65). Conclusions A greater variability in SBP and DBP is independently associated with greater risk of incident HF in individuals with Type 2 diabetes.

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Section: Discussionsupporting

confidence: 90%

Long‐term variability of blood pressure and incidence of heart failure among individuals with Type 2 diabetes

Kazé

Santhanam²,

Erqou

et al. 2021

ESC Heart Failure

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“…The ASPREE trial also demonstrated a higher risk of HF events with higher SBP variability. In patients with type 2 diabetes from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial and the Veterans Affairs Diabetes Trial (ADT), BP variability measured by SBP and DBP were both associated with increased risk of HF, even after adjusting for other risk factors and mean BP (9). The current study builds on these previous works to clarify that the MAP variability, similar to SBP or DBP variability, was also associated with the risks of HF and death.…”

Section: Discussionmentioning

confidence: 99%

“…The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) (1) and 2018 European Society of Cardiology (ESC)/European Society of Hypertension (ESH) (2) blood pressure (BP) guideline recommends using a single measurement or the average of BP levels assessed over time to screen for and manage high BP in adults, while occasional BP increase or reduction has not been taken seriously by clinicians. Although fluctuation of BP is physiological (3), a growing number of clinical and observational studies have demonstrated that elevated BP variability contributes to the risk of cardiovascular disease (CVD) and death, independently of mean BP (4)(5)(6)(7)(8)(9)(10)(11)(12). Thus, BP variability has increasingly been recognized as a novel CVD risk factor that can provide more accurate estimates for the clinical outcomes in adults (13).…”

Section: Introductionmentioning

confidence: 99%

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Long-Term Visit-to-Visit Mean Arterial Pressure Variability and the Risk of Heart Failure and All-Cause Mortality

Liu

Chen

Zhang

et al. 2021

Front. Cardiovasc. Med.

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Background: Systolic or diastolic blood pressure (BP) variability is associated with an increased risk of cardiovascular events. We assessed whether BP variability measured by mean arterial pressure (MAP) was associated with increased risk of heart failure (HF) and death in individuals with or without hypertension.Methods: We evaluated 9,305 Atherosclerosis Risk in Communities (ARIC) study participants with or without hypertension and calculated BP variability based on MAP values from visit 1 to 4 [expressed as standard deviation (SD), average real variability (ARV), coefficient of variation (CV), and variability independent of the mean (VIM)]. Multivariate-adjusted Cox regression model and restricted cubic spline curve were used to evaluate the associations of MAP variability with all-cause mortality and HF.Results: During a median follow-up of 16.8 years, 1,511 had an HF event and 2,903 died. Individuals in the highest quartile of VIM were both associated with a 21% higher risk of all-cause mortality [hazard ratio (HR), 1.21; 95% CI, 1.09–1.35] and HF (HR, 1.21; 95% CI, 1.04–1.39) compared with the lowest quartile of VIM. Cubic spline curves reveal that the risk of deaths and HF increased with MAP variability when it reached a higher level. Results were similar in individuals with normotension (all-cause mortality: HR, 1.30; 95% CI, 1.09–1.55; HF, HR, 1.49; 95% CI, 1.12–1.98).Conclusions: In individuals with or without hypertension, greater visit-to-visit MAP variability was associated with a higher risk of all-cause mortality and HF, indicating that the BP variability assessed by MAP might be a potential risk factor for HF and death.

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“…Very recently, pooled data from the ACCORD and VADT Trials have shown that both systolic and diastolic blood pressure variability can favor the development of heart failure in T2D, an effect likely mediated by dips, not elevations, of blood pressure [ 15 ].…”

Section: Variability Of Risk Factors and Diabetic Complicationsmentioning

confidence: 99%

Variability of risk factors and diabetes complications

Ceriello

Prattichizzo

2021

Cardiovasc Diabetol

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Several studies suggest that, together with glucose variability, the variability of other risk factors, as blood pressure, plasma lipids, heart rate, body weight, and serum uric acid, might play a role in the development of diabetes complications. Moreover, the variability of each risk factor, when contemporarily present, may have additive effects. However, the question is whether variability is causal or a marker. Evidence shows that the quality of care and the attainment of the target impact on the variability of all risk factors. On the other hand, for some of them causality may be considered. Although specific studies are still lacking, it should be useful checking the variability of a risk factor, together with its magnitude out of the normal range, in clinical practice. This can lead to an improvement of the quality of care, which, in turn, could further hesitate in an improvement of risk factors variability.

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Blood Pressure Variability and Risk of Heart Failure in ACCORD and the VADT

Cited by 30 publications

References 30 publications

Long‐term variability of blood pressure and incidence of heart failure among individuals with Type 2 diabetes

Long‐term variability of blood pressure and incidence of heart failure among individuals with Type 2 diabetes

Long-Term Visit-to-Visit Mean Arterial Pressure Variability and the Risk of Heart Failure and All-Cause Mortality

Variability of risk factors and diabetes complications

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