What is the clinical evidence from this study?

Study design: Cohort. Population: Type 2 diabetes. Intervention: Blood pressure variability. Primary outcome: Heart failure (HR 1.15, p=0.01).

What question did this study set out to answer?

To determine whether visit-to-visit blood pressure variability independently predicts the risk of developing heart failure in patients with type 2 diabetes.

April 23, 2020Diabetes CareOpen Access

Blood Pressure Variability and Risk of Heart Failure in ACCORD and the VADT

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Key result

Higher systolic blood pressure variability was associated with an increased risk of heart failure in individuals with type 2 diabetes (HR 1.15, P=0.01).

Why the study?

Although blood pressure variability is recognized as a cardiovascular risk factor, its relationship with heart failure remains less clear.

Is blood pressure variability associated with an increased risk of heart failure in individuals with type 2 diabetes?

Population

Patients with type 2 diabetes participating in the ACCORD and VADT trials

Comparison

Higher vs lower blood pressure variability

Design

Two-cohort post hoc trial analysis

Authors

DNDaniel S. NuyujukianWinston-Salem/Forsyth County Schools JKJuraj KoskaPhoenix VA Health Care System GBGideon BahnEdward Hines, Jr. VA Hospital

Discussion

Member takes

Implication

BP variability may flag HF risk in T2D but should not change practice; leaves open whether it is a modifiable target.

Key Points

To determine whether visit-to-visit blood pressure variability independently predicts the risk of developing heart failure in patients with type 2 diabetes.
Analyzed longitudinal data from two clinical trials: Action to Control Cardiovascular Risk in Diabetes (ACCORD) and the Veterans Affairs Diabetes Trial (VADT).
Calculated systolic and diastolic blood pressure variability using coefficient of variation (CV) and average real variability (ARV), alongside maximum and cumulative mean blood pressures.
In ACCORD, higher systolic and diastolic variability independently predicted heart failure after adjusting for mean blood pressure (CV-SBP: HR 1.15, P = 0.01; CV-DBP: HR 1.18, P = 0.003).
In VADT, elevated diastolic blood pressure variability was similarly linked to increased heart failure risk (ARV-DBP: HR 1.16, P = 0.001; CV-DBP: HR 1.09, P = 0.04).
In ACCORD, patients with lower baseline blood pressure faced a stepwise risk increase at higher variability levels, with heart failure risk driven specifically by transient dips rather than spikes in pressure.

Study Design

Type

Cohort

Structured PICO

Is blood pressure variability associated with an increased risk of heart failure in individuals with type 2 diabetes?

Population

Individuals with type 2 diabetes from the ACCORD and VADT cohorts.

Exposure

Higher blood pressure variability (measured by coefficient of variation [CV] and average real variability [ARV] for systolic and diastolic blood pressure)

Comparator

Lower blood pressure variability

Outcome

Risk of heart failurehard clinical

Main Result

Hazard Ratio: 1.15

p-value: p=0.01

Blood pressure variability, particularly dips in blood pressure, is associated with an increased risk of heart failure in patients with type 2 diabetes.

Cite This Study

Nuyujukian et al. (2020) conducted a cohort in Type 2 diabetes. Blood pressure variability was evaluated on Heart failure (HR 1.15, p=0.01). Higher systolic blood pressure variability was associated with an increased risk of heart failure in individuals with type 2 diabetes (HR 1.15, P=0.01).

synapsesocial.com/papers/6a7f422cb4cedf233c7ca397 https://doi.org/10.2337/dc19-2540

Topics

Heart failure HFrEF treatment Hypertension management Women and heart disease

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Blood Pressure Variability and Risk of Heart Failure in ACCORD and the VADT

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Topics

Blood Pressure Variability and Risk of Heart Failure in ACCORD and the VADT

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Also Consider

Topics

Also Consider