Visit‐to‐visit variability in blood pressure strongly predicts all‐cause mortality in patients with type 2 diabetes: a 5·5‐year prospective analysis

Hsieh, Yi‐Ting; Tu, Shih‐Te; Cho, Tzu-Jung; Chang, Shun‐Jen; Chen, Jung‐Fu; Hsieh, Ming‐Chia

doi:10.1111/j.1365-2362.2011.02574.x

Cited by 105 publications

(100 citation statements)

References 25 publications

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“…18 However, there has been little investigation of the effects of BP variability on cardiovascular events among patients with type 2 diabetes mellitus. 19 The analyses reported here expand the findings of previous studies and suggest that the association of visit-to-visit SBP variability with cardiovascular events is also observed in patients with type 2 diabetes mellitus.…”

Section: 18-21supporting

confidence: 74%

Effects of Visit-to-Visit Variability in Systolic Blood Pressure on Macrovascular and Microvascular Complications in Patients With Type 2 Diabetes Mellitus

et al. 2013

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A recent study of several cohorts of patients with previous transient ischemic attack or stroke and of the AngloScandinavian Cardiac Outcomes Trial Blood Pressure Lowering Arm (ASCOT-BPLA) reported that visit-to-visit Background-Recent evidence suggests that visit-to-visit variability in systolic blood pressure (SBP) and maximum SBP are predictors of cardiovascular disease. However, it remains uncertain whether these parameters predict the risks of macrovascular and microvascular complications in patients with type 2 diabetes mellitus. Methods and Results-The Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) was a factorial randomized controlled trial of blood pressure lowering and blood glucose control in patients with type 2 diabetes mellitus. The present analysis included 8811 patients without major macrovascular and microvascular events or death during the first 24 months after randomization. SBP variability (defined as standard deviation) and maximum SBP were determined during the first 24 months after randomization. During a median 2.4 years of follow-up from the 24-month visit, 407 major macrovascular (myocardial infarction, stroke, or cardiovascular death) and 476 microvascular (new or worsening nephropathy or retinopathy) events were observed.

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Section: 18-21supporting

confidence: 74%

Effects of Visit-to-Visit Variability in Systolic Blood Pressure on Macrovascular and Microvascular Complications in Patients With Type 2 Diabetes Mellitus

et al. 2013

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“…In the largest of these, in which 2161 individuals with type 2 diabetes were followed for a mean of 67 months, every 1 SD higher SBV (a metric similar to what we have analyzed) was independently associated with a 5% higher risk of all-cause mortality (23). Similarly, among 956 individuals from NHANES III followed for a median of 14 years, the HR for death was 1.50 (95% CI, 1.03-2.18) in the highest compared with lowest tertile of SBV (2).…”

Section: Discussionmentioning

confidence: 99%

Association of BP Variability with Mortality among African Americans with CKD

McMullan

Bakris

Phillips

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Increased systolic BP visit-to-visit variability (SBV) may be associated with higher overall mortality and cardiovascular events. However, few studies have examined these associations in patients with CKD, and the relation of SBV with CKD progression and ESRD has not been shown. This study analyzed the association of SBV with overall mortality, cardiovascular mortality, cardiovascular events, and renal events among individuals enrolled in the African American Study of Kidney Disease (AASK) trial.Design, setting, participants, & measurements This was a prospective observational study of 908 participants during the trial phase of the AASK study, with at least 1 year of BP measurements available and followed for 3-6.4 years. SBV was calculated as the SD of the systolic pressure from five visits occurring 3-12 months after randomization. The association of SBV with risk of overall mortality, cardiovascular mortality, a composite of fatal and nonfatal cardiovascular events, and a composite of renal events was assessed using proportional hazards regression and adjusting for multiple potential confounders.Results Greater SBV was associated with higher overall mortality. The adjusted hazard ratio (95% confidence interval) was 2.82 (1.14-6.95) comparing the highest with lowest tertile of SBV. A similar comparison revealed that greater SBV was also associated with cardiovascular mortality (adjusted hazard ratio, 4.91; 1.12-21.50). SBV was associated with both the cardiovascular renal composite endpoints in unadjusted but not adjusted analyses.Conclusions In African Americans with CKD, SBV is strongly and independently associated with overall and cardiovascular mortality.

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“…In patients with type 2 diabetes, visit-to-visit BP variability was reported to be an independent predictor of macrovascular complications (Hata et al, 2013), and all-cause mortality (Hsieh et al, 2012). It has been suggested that increased BP variability may reflect arterial stiffness and baroreceptor dysfunction, which have been associated with arteriosclerosis and can result in vascular events (Floras et al, 1988;Hata et al, 2000Hata et al, , 2002Rothwell, 2010;Shan, Dai, & Su, 2001).…”

Section: Introductionmentioning

confidence: 98%

Relationships between the risk of cardiovascular disease in type 2 diabetes patients and both visit-to-visit variability and time-to-effect differences in blood pressure

Takao

Kimura

Suka

et al. 2015

Journal of Diabetes and its Complications

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Visit‐to‐visit variability in blood pressure strongly predicts all‐cause mortality in patients with type 2 diabetes: a 5·5‐year prospective analysis

Cited by 105 publications

References 25 publications

Effects of Visit-to-Visit Variability in Systolic Blood Pressure on Macrovascular and Microvascular Complications in Patients With Type 2 Diabetes Mellitus

Effects of Visit-to-Visit Variability in Systolic Blood Pressure on Macrovascular and Microvascular Complications in Patients With Type 2 Diabetes Mellitus

Association of BP Variability with Mortality among African Americans with CKD

Relationships between the risk of cardiovascular disease in type 2 diabetes patients and both visit-to-visit variability and time-to-effect differences in blood pressure

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