Long-Term Variability of Blood Pressure, Cardiovascular Outcomes, and Mortality: The Look AHEAD Study.
blood pressure
blood pressure variability
cardiovascular diseases
diabetes
hypertension
mortality
Journal
American journal of hypertension
ISSN: 1941-7225
Titre abrégé: Am J Hypertens
Pays: United States
ID NLM: 8803676
Informations de publication
Date de publication:
09 08 2021
09 08 2021
Historique:
received:
02
09
2020
revised:
09
11
2020
accepted:
31
03
2021
pubmed:
8
4
2021
medline:
15
12
2021
entrez:
7
4
2021
Statut:
ppublish
Résumé
We evaluated the associations of visit-to-visit blood pressure (BP) variability with incident cardiovascular disease (CVD) and deaths in adults with type 2 diabetes. We analyzed 4,152 participants in Look AHEAD (Action for Health in Diabetes) free of CVD events and deaths during the first 36 months of follow-up. Variability of systolic BP (SBP) and diastolic BP (DBP) across 4 annual visits was assessed using the intraindividual SD, variation independent of the mean, and coefficient of variation. Cox regression was used to generate the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for CVD (myocardial infarction [MI], stroke, or CVD-related deaths) and mortality. Over a median of 6.6 years, there were 220 MIs, 105 stroke cases, 62 CVD-related deaths, and 236 deaths. After adjustment for confounders including average BP, the aHRs for the highest (vs. lowest) tertile of SD of SBP were 1.98 (95% CI 1.01-3.92), 1.25 (95% CI 0.90-1.72), 1.26 (95% CI 0.96-1.64), 1.05 (95% CI 0.75-1.46), and 1.64 (95% CI 0.99-2.72) for CVD mortality, all-cause mortality, CVD, MI, and stroke, respectively. The equivalent aHRs for SD of DBP were 1.84 (95% CI 0.98-3.48), 1.43 (95% CI 1.03-1.98), 1.19 (95% CI 0.91-1.56), 1.14 (95% CI 0.82-1.58), and 0.97 (95% CI 0.58-1.60), respectively. In a large sample of individuals with type 2 diabetes, a greater variability in SBP was associated with higher cardiovascular mortality and CVD events; a higher variability in DBP was linked to increased overall and cardiovascular mortality.
Sections du résumé
BACKGROUND
We evaluated the associations of visit-to-visit blood pressure (BP) variability with incident cardiovascular disease (CVD) and deaths in adults with type 2 diabetes.
METHODS
We analyzed 4,152 participants in Look AHEAD (Action for Health in Diabetes) free of CVD events and deaths during the first 36 months of follow-up. Variability of systolic BP (SBP) and diastolic BP (DBP) across 4 annual visits was assessed using the intraindividual SD, variation independent of the mean, and coefficient of variation. Cox regression was used to generate the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for CVD (myocardial infarction [MI], stroke, or CVD-related deaths) and mortality.
RESULTS
Over a median of 6.6 years, there were 220 MIs, 105 stroke cases, 62 CVD-related deaths, and 236 deaths. After adjustment for confounders including average BP, the aHRs for the highest (vs. lowest) tertile of SD of SBP were 1.98 (95% CI 1.01-3.92), 1.25 (95% CI 0.90-1.72), 1.26 (95% CI 0.96-1.64), 1.05 (95% CI 0.75-1.46), and 1.64 (95% CI 0.99-2.72) for CVD mortality, all-cause mortality, CVD, MI, and stroke, respectively. The equivalent aHRs for SD of DBP were 1.84 (95% CI 0.98-3.48), 1.43 (95% CI 1.03-1.98), 1.19 (95% CI 0.91-1.56), 1.14 (95% CI 0.82-1.58), and 0.97 (95% CI 0.58-1.60), respectively.
CONCLUSIONS
In a large sample of individuals with type 2 diabetes, a greater variability in SBP was associated with higher cardiovascular mortality and CVD events; a higher variability in DBP was linked to increased overall and cardiovascular mortality.
Identifiants
pubmed: 33825813
pii: 6213785
doi: 10.1093/ajh/hpaa210
pmc: PMC8351510
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
689-697Subventions
Organisme : NHLBI NIH HHS
ID : K23 HL153774
Pays : United States
Informations de copyright
© American Journal of Hypertension, Ltd 2021. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
Références
Control Clin Trials. 2003 Oct;24(5):610-28
pubmed: 14500058
JAMA. 2015 Sep 8;314(10):1021-9
pubmed: 26348752
Am J Kidney Dis. 2014 Nov;64(5):714-22
pubmed: 25064674
Eur Heart J. 2018 Jun 21;39(24):2243-2251
pubmed: 29365085
Diabetes Care. 2003 May;26(5):1553-79
pubmed: 12716821
Circulation. 2020 Mar 3;141(9):e139-e596
pubmed: 31992061
Ann Intern Med. 2009 May 5;150(9):604-12
pubmed: 19414839
Clin Chem. 1982 Jun;28(6):1379-88
pubmed: 7074948
J Am Coll Cardiol. 2014 Feb 25;63(7):636-646
pubmed: 24239664
Lancet Diabetes Endocrinol. 2016 Jul;4(7):588-97
pubmed: 27216886
J Hypertens Suppl. 1992 Aug;10(6):S73-7
pubmed: 1432333
Diabetes Obes Metab. 2019 Dec;21(12):2587-2598
pubmed: 31282073
Cardiovasc Diabetol. 2020 May 2;19(1):50
pubmed: 32359350
Diabetes Care. 2007 Feb;30(2):292-9
pubmed: 17259497
Ann Intern Med. 2015 Sep 1;163(5):329-38
pubmed: 26215765
Curr Opin Cardiol. 2006 Sep;21(5):486-91
pubmed: 16900013
Hypertension. 2014 Nov;64(5):965-82
pubmed: 25069669
Curr Diab Rep. 2018 Oct 25;18(12):137
pubmed: 30361834
Stroke. 2019 Nov;50(11):3170-3176
pubmed: 31537194
Hypertension. 2017 Aug;70(2):461-468
pubmed: 28584014
J Clin Hypertens (Greenwich). 2012 Nov;14(11):744-50
pubmed: 23126345
Methods Enzymol. 1986;129:101-23
pubmed: 3724535
BMJ. 2016 Aug 09;354:i4098
pubmed: 27511067
Diabetes Care. 2017 Feb;40(2):270-279
pubmed: 27899498
J Am Coll Cardiol. 2016 Sep 27;68(13):1375-1386
pubmed: 27659458
Diab Vasc Dis Res. 2006 Dec;3(3):202-15
pubmed: 17160917
Hypertension. 2012 Sep;60(3):625-30
pubmed: 22753206
Eur J Clin Invest. 2012 Mar;42(3):245-53
pubmed: 21815887
Hypertension. 2018 Oct;72(4):1002-1010
pubmed: 30354707
Curr Hypertens Rep. 2009 Jun;11(3):199-205
pubmed: 19442329
Diabetes Care. 2020 Jan;43(Suppl 1):S111-S134
pubmed: 31862753
Circulation. 2013 Sep 17;128(12):1325-34
pubmed: 23926207