Key result
Higher systolic blood pressure variability linked to ~26% greater CVD and mortality risk per 5 mm Hg.
Why the study?
The detrimental effects of increased variability in systolic blood pressure on cardiovascular disease and mortality risk in patients with diabetes mellitus remain unclear.
Does increased usual systolic blood pressure visit-to-visit variability increase the risk of cardiovascular disease and all-cause mortality in patients with type 2 diabetes mellitus?
Cohort (n=155,982)
Yes
Does increased usual systolic blood pressure visit-to-visit variability increase the risk of cardiovascular disease and all-cause mortality in patients with type 2 diabetes mellitus?
Elevated visit-to-visit variability of systolic blood pressure is an independent risk factor for cardiovascular disease and mortality in type 2 diabetes mellitus, particularly affecting younger patients.
Answers are grounded in this paper and cite their sources.
SBP variability may flag higher CVD risk in T2DM; hypothesis-generating and leaves causal role or intervention effects open.
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.
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Wan et al. (2021) conducted a cohort in Type 2 diabetes mellitus (n=155,982). Elevated systolic blood pressure visit-to-visit variability vs. Lower systolic blood pressure visit-to-visit variability was evaluated on Composite of incidence of cardiovascular disease and all-cause mortality (HR 1.26 per 5 mm Hg increase, 95% CI 1.23-1.30). Each 5 mm Hg increase in usual systolic blood pressure visit-to-visit variability was independently associated with a 26% higher risk of the composite of cardiovascular disease and all-cause mortality.
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