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

Authors

  • Yi-Ting Hsieh,

    1. Department of Ophthalmology, Buddhist Tzu Chi General Hospital, Taipei Branch, Taipei, Taiwan
    2. Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
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  • Shih-Te Tu,

    1. Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
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  • Tzu-Jung Cho,

    1. Department of Dermatology, Cathay General Hospital, Taipei, Taiwan
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  • Shun-Jen Chang,

    1. Department of Public Health, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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  • Jung-Fu Chen,

    1. Department of Nutrition Therapy and Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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  • Ming-Chia Hsieh

    1. Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
    2. Graduate Institute of Integrated Medicine, China Medical University, Taiwan
    3. Department of Internal Medicine, Chung Shan Medical University, Taichung, Taiwan
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  • Yi-Ting Hsieh and Shih-Te Tu contributed equally to this work.

Dr Ming-Chia Hsieh, Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, 135 Nanhsiao Street, Changhua 500, Taiwan. Tel.: +886 4 7238595 Ext. 1371; fax: +886 4 7238595; e-mail: mingchiah@gmail.com

Abstract

Eur J Clin Invest 2012; 42 (3): 245–253

Abstract

Background  Elevations in blood pressure and visit-to-visit variability have been found to significantly increase the risk of cardiovascular morbidity and mortality in nondiabetic individuals. This study has assessed the association between all-cause mortality and blood pressure parameters [systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), mean arterial pressure (MAP) and visit-to-visit variability] in patients with type 2 diabetes.

Materials and methods  A longitudinal cohort study of 2161 patients with type 2 diabetes and a mean follow-up period of 66·7 ± 7·5 months. Using Cox regression models, blood pressure parameters were related to the risk of all-cause mortality.

Results  Visit-to-visit variability in SBP [HR: 1·048 (95% CI: 1·005–1·092; P = 0·03)], DBP [HR: 1·090 (95% CI: 1·021–1·163; P = 0·01)] and MAP [HR: 1·099 (95% CI: 1·033–1·170; P = 0·003)] significantly predicted all-cause mortality in patients with type 2 diabetes after adjusting for baseline data, mean follow-up blood pressure profiles and HbA1c. Visit-to-visit variability in PP [HR: 1·139 (95% CI: 1·030–1·258; P = 0·01)] significantly predicted cardiovascular mortality. Neither baseline nor follow-up SBP, DBP, PP nor MAP was significantly associated with all-cause and cardiovascular mortality after adjusting for blood pressure variability. The risk of all-cause mortality with a mean follow-up SBP has a U-shaped distribution. Patients with a mean follow-up DBP > 90 mmHg were at higher risk of mortality than those with DBP < 90 mmHg.

Conclusions  Visit-to-visit variability in blood pressure was significantly associated with all-cause mortality independent of mean BP in patients with type 2 diabetes. The data for blood pressure variability might be regarded as a potentially important therapeutic target in the management of type 2 diabetes.

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