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Visit‐to‐visit variability in blood pressure strongly predicts all‐cause mortality in patients with type 2 diabetes: a 5·5‐year prospective analysis
Author(s) -
Hsieh YiTing,
Tu ShihTe,
Cho TzuJung,
Chang ShunJen,
Chen JungFu,
Hsieh MingChia
Publication year - 2012
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/j.1365-2362.2011.02574.x
Subject(s) - medicine , blood pressure , diabetes mellitus , pulse pressure , type 2 diabetes , cardiology , proportional hazards model , prospective cohort study , cohort , cohort study , mean arterial pressure , endocrinology , heart rate
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.