Department of Clinical and Experimental Medicine, Università degli Studi di Pisa, Pisa, Italy.
Department of Medicine, Sant'Anna School of Advanced Studies, Pisa, Italy.
Diabetes Obes Metab. 2019 Dec;21(12):2587-2598. doi: 10.1111/dom.13828. Epub 2019 Aug 9.
To investigate the associations of blood pressure variability (BPV), expressed as long-term (visit-to-visit) and short-term (ambulatory blood pressure monitoring [ABPM] and home blood pressure monitoring [HBPM]) and all-cause mortality, major adverse cardiovascular events (MACEs), extended MACEs, microvascular complications (MiCs) and hypertension-mediated organ damage (HMOD) in adult patients with type 2 diabetes.
PubMed, Medline, Embase, Cinahl, Web of Science, ClinicalTrials.gov and grey literature databases were searched for studies including patients with type 2 diabetes, at least one variable of BPV (visit-to-visit, HBPM, ABPM) and evaluation of the incidence of at least one of the following outcomes: all-cause mortality, MACEs, extended MACEs and/or MiCs and/or HMOD. The extracted information was analyzed using random effects meta-analysis and meta-regression.
Data from a total of 377 305 patients were analyzed. Systolic blood pressure (SBP) variability was associated with a significantly increased risk of all-cause mortality (HR 1.12, 95% CI 1.04-1.21), MACEs (HR 1.01, 95% CI 1.04-1.17), extended MACEs (HR 1.07, 95% CI 1.03-1.11) and MiCs (HR 1. 12, 95% CI 1.01-1.24), while diastolic blood pressure was not. Associations were mainly driven from studies on long-term SBP variability. Qualitative analysis showed that BPV was associated with the presence of HMOD expressed as carotid intima-media thickness, pulse wave velocity and left ventricular hypertrophy. Results were independent of mean blood pressure, glycaemic control and serum creatinine levels.
Our results suggest that BPV might provide additional information rather than mean blood pressure on the risk of cardiovascular disease in patients with type 2 diabetes.
探讨血压变异性（BPV）与全因死亡率、主要不良心血管事件（MACEs）、扩展 MACEs、微血管并发症（MiCs）和高血压介导的器官损害（HMOD）的关系，BPV 包括长期（随访间）和短期（动态血压监测[ABPM]和家庭血压监测[HBPM]）的血压变异性。
在 PubMed、Medline、Embase、Cinahl、Web of Science、ClinicalTrials.gov 和灰色文献数据库中搜索了包括 2 型糖尿病患者在内的研究，这些患者至少有一项 BPV 变量（随访间、HBPM、ABPM），并评估了以下至少一种结果的发生率：全因死亡率、MACEs、扩展 MACEs 和/或 MiCs 和/或 HMOD。使用随机效应荟萃分析和荟萃回归分析提取的信息。
共分析了 377305 名患者的数据。收缩压变异性（SBPV）与全因死亡率（HR 1.12，95%CI 1.04-1.21）、MACEs（HR 1.01，95%CI 1.04-1.17）、扩展 MACEs（HR 1.07，95%CI 1.03-1.11）和 MiCs（HR 1.12，95%CI 1.01-1.24）的风险显著增加相关，而舒张压则没有。这些关联主要来自于长期 SBPV 变异性的研究。定性分析表明，BPV 与颈动脉内膜中层厚度、脉搏波速度和左心室肥厚等 HMOD 的存在相关。结果独立于平均血压、血糖控制和血清肌酐水平。
我们的研究结果表明，BPV 可能比平均血压提供更多关于 2 型糖尿病患者心血管疾病风险的信息。
