Blood Pressure Variability Remains an Elusive Predictor of Cardiovascular Outcome
Key result
Short-term night time blood pressure variability during sleep remained a significant predictor of a composite cardiovascular outcome in patients with uncomplicated type 2 diabetes.
Why the study?
Does short-term night time blood pressure variability predict cardiovascular outcomes in patients with uncomplicated type 2 diabetes?
Population
300 Japanese patients with uncomplicated type 2 diabetes
Design
Editorial
Authors
Discussion
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Implication
While night-time blood pressure variability predicts cardiovascular events in type 2 diabetes, methodological limitations and confounding factors make it an elusive prognostic index.
Key Points
- This study investigates the relationship between blood pressure variability and cardiovascular outcomes in type 2 diabetes patients.
- Evaluated 300 Japanese patients with uncomplicated type 2 diabetes.
- Assessed blood pressure variability using standard deviation during sleep and day.
- Adjustments made for age, smoking, and blood pressure measurement methods.
- Short-term night time blood pressure variability predicted cardiovascular events (HR not specified).
- No significant predictive value for day time variability or morning surge was found.
- Concerns about statistical power and model collinearity were noted due to the low number of cardiovascular events.
Structured PICO
Does short-term night time blood pressure variability predict cardiovascular outcomes in patients with uncomplicated type 2 diabetes?
P
Population
300 Japanese patients with uncomplicated type 2 diabetes, mostly off medication, evaluated for the prognostic significance of short-term night time blood pressure variability.
E
Exposure
Short-term night time blood pressure variability (standard deviation of systolic or diastolic blood pressure during sleep)
O
Outcome
Composite cardiovascular end point consisting of stroke (not including transient ischemic attack), myocardial infarction, and sudden cardiac deathcomposite
While night-time blood pressure variability predicts cardiovascular events in type 2 diabetes, methodological limitations and confounding factors make it an elusive prognostic index.
Limitations
- Low number of end points (29 events) made proper estimates of multivariable-adjusted hazard ratios impossible
- Collinearity between explanatory variables in the Cox model
- Models did not include sex, body mass index, or serum creatinine
- Physical activity and emotional stimuli cannot be standardized, explaining low reproducibility
- Potential for reverse causality, where increased blood pressure variability is a marker of underlying disease rather than an independent predictor
- Low number of end points (29 cardiovascular events)
- Reverse causality
Cite This Study
Hansen et al. (2008) conducted an editorial in Type 2 diabetes (n=300). Short-term night time blood pressure variability was evaluated on Composite cardiovascular end point consisting of stroke (not including transient ischemic attack), myocardial infarction, and sudden cardiac death. Short-term night time blood pressure variability during sleep remained a significant predictor of a composite cardiovascular outcome in patients with uncomplicated type 2 diabetes.