Elevated SBP visit-to-visit variability was associated with higher CVD and mortality risk across all ages, with a stronger effect in younger patients (HR 1.66, 95% CI 1.49-1.85 for ages 45-54).
Cohort (n=155,982)
Does increased visit-to-visit systolic blood pressure variability increase the risk of cardiovascular disease and mortality in patients with type 2 diabetes?
Increased visit-to-visit systolic blood pressure variability is strongly associated with higher cardiovascular and mortality risk in patients with type 2 diabetes, with a more pronounced effect in younger patients.
Hazard Ratio: 1.66 (95% CI 1.49–1.85)
Background The detrimental effects of increased variability in systolic blood pressure (SBP) on cardiovascular disease (CVD) and mortality risk in patients with diabetes mellitus remains unclear. This study evaluated age-specific association of usual SBP visit-to-visit variability with CVD and mortality in patients with type 2 diabetes mellitus. Methods and Results A retrospective cohort study investigated 155 982 patients with diabetes mellitus aged 45 to 84 years without CVD at baseline (2008-2010). Usual SBP variability was estimated using SBP SD obtained from a mixed-effects model. Age-specific associations (45-54, 55-64, 65-74, 75-84 years) between usual SBP variability, CVD, and mortality risk were assessed by Cox regression adjusted for patient characteristics. After a median follow-up of 9.7 years, 49 816 events (including 34 039 CVD events and 29 211 mortalities) were identified. Elevated SBP variability was independently, positively, and log-linearly associated with higher CVD and mortality risk among all age groups, with no evidence of any threshold effects. The excess CVD and mortality risk per 5 mm Hg increase in SBP variability within the 45 to 54 age group is >3 times higher than the 70 to 79 age group (hazard ratio, 1.66; 95% CI, 1.49-1.85 versus hazard ratio, 1.19; 95% CI, 1.15-1.23). The significant associations remained consistent among all subgroups. Patients with younger age had a higher association of SBP variability with event outcomes. Conclusions The findings suggest that SBP visit-to-visit variability was strongly associated with CVD and mortality with no evidence of a threshold effect in a population with diabetes mellitus. As well as controlling overall blood pressure levels, SBP visit-to-visit variability should be monitored and evaluated in routine practice, in particular for younger patients.
Wan et al. (Mon,) conducted a cohort in Type 2 diabetes mellitus (n=155,982). Elevated systolic blood pressure visit-to-visit variability vs. Lower systolic blood pressure variability was evaluated on Cardiovascular disease and mortality (HR 1.66, 95% CI 1.49-1.85). Elevated SBP visit-to-visit variability was associated with higher CVD and mortality risk across all ages, with a stronger effect in younger patients (HR 1.66, 95% CI 1.49-1.85 for ages 45-54).