Health Innovation Program, University of Wisconsin, Madison, Wisconsin.
Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines.
J Hypertens. 2018 Nov;36(11):2177-2184. doi: 10.1097/HJH.0000000000001783.
SBP variability may be a target for mitigating end-organ damage associated with vascular disease. We evaluated the relationship between increased SBP variability and risk of incident diabetic foot ulceration.
Using a nested case-control design, we followed patients diagnosed with diabetes and treated within the US Department of Veterans Affairs Healthcare system for development of a diabetic foot ulcer (event) between 2006 and 2010. Each case was randomly matched to up to five controls based on age, sex, race/ethnicity, and calendar time. SBP variability was computed using at least three blood pressure measurements from the year preceding the event. The association between SBP variability and foot ulceration was examined using conditional logistic regression. Potential protective effects of calcium channel blockers, which blunt SBP variability, were also explored.
The study sample included 51 111 cases and 129 247 controls. Compared with those in quartile 1 (lowest variability), patients in quartiles 2-4 had higher adjusted odds ratios for diabetic foot ulcer development: 1.11 (95% CI 1.07-1.16), 1.20 (95% CI 1.15-1.25), 1.29 (95% CI 1.24-1.34) (P for trend <0.001). Calcium channel blockers were associated with reduced risks of ulceration for those without peripheral vascular disease (OR = 0.87, 95% CI 0.84-0.90, P < 0.001) or neuropathy (OR = 0.85, 95% CI 0.82-0.89, P < 0.001) in adjusted subgroup analyses.
This study describes a graded relationship between SBP variability and risk of diabetic foot ulceration, providing a potential new and modifiable target to reduce this common complication.
收缩压变异性（SBP 变异）可能是减轻与血管疾病相关的靶器官损伤的一个目标。我们评估了 SBP 变异增加与新发糖尿病足溃疡（DFU）风险之间的关系。
我们采用巢式病例对照设计，对 2006 年至 2010 年期间在美国退伍军人事务部医疗保健系统内接受治疗的糖尿病患者进行随访，以观察他们是否发生了糖尿病足溃疡（事件）。每例病例均根据年龄、性别、种族/民族和时间按 1:5 的比例随机匹配对照。使用事件前至少 3 次血压测量值计算 SBP 变异性。采用条件逻辑回归检验 SBP 变异性与足部溃疡之间的关联。还探讨了钙通道阻滞剂（可减弱 SBP 变异性）的潜在保护作用。
本研究样本包括 51111 例病例和 129247 例对照。与 SBP 变异最低四分位组（1 组）相比，SBP 变异较高四分位组（2-4 组）患者的糖尿病足溃疡发病的校正比值比更高：1.11（95%置信区间，1.07-1.16）、1.20（95%置信区间，1.15-1.25）、1.29（95%置信区间，1.24-1.34）（P 趋势<0.001）。在校正亚组分析中，钙通道阻滞剂与无外周血管疾病（比值比，0.87；95%置信区间，0.84-0.90；P<0.001）或神经病变（比值比，0.85；95%置信区间，0.82-0.89；P<0.001）患者的溃疡风险降低相关。
本研究描述了 SBP 变异与糖尿病足溃疡风险之间的关系呈梯度性，为降低这种常见并发症提供了一个新的潜在可改变的目标。
