Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
Carl T. Hayden Veterans Affairs Medical Center, Phoenix, AZ.
Diabetes Care. 2020 Jul;43(7):1471-1478. doi: 10.2337/dc19-2540. Epub 2020 Apr 23.
Although blood pressure variability is increasingly appreciated as a risk factor for cardiovascular disease, its relationship with heart failure (HF) is less clear. We examined the relationship between blood pressure variability and risk of HF in two cohorts of type 2 diabetes participating in trials of glucose and/or other risk factor management.
Data were drawn from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial and the Veterans Affairs Diabetes Trial (VADT). Coefficient of variation (CV) and average real variability (ARV) were calculated for systolic (SBP) and diastolic blood pressure (DBP) along with maximum and cumulative mean SBP and DBP during both trials.
In ACCORD, CV and ARV of SBP and DBP were associated with increased risk of HF, even after adjusting for other risk factors and mean blood pressure (e.g., CV-SBP: hazard ratio [HR] 1.15, = 0.01; CV-DBP: HR 1.18, = 0.003). In the VADT, DBP variability was associated with increased risk of HF (ARV-DBP: HR 1.16, = 0.001; CV-DBP: HR 1.09, = 0.04). Further, in ACCORD, those with progressively lower baseline blood pressure demonstrated a stepwise increase in risk of HF with higher CV-SBP, ARV-SBP, and CV-DBP. Effects of blood pressure variability were related to dips, not elevations, in blood pressure.
Blood pressure variability is associated with HF risk in individuals with type 2 diabetes, possibly a consequence of periods of ischemia during diastole. These results may have implications for optimizing blood pressure treatment strategies in those with type 2 diabetes.
尽管血压变异性作为心血管疾病的一个危险因素日益受到关注，但它与心力衰竭（HF）的关系尚不清楚。我们在两个 2 型糖尿病临床试验队列中检查了血压变异性与 HF 风险之间的关系，这些临床试验涉及葡萄糖和/或其他危险因素的管理。
数据来自心血管风险降低行动（ACCORD）试验和退伍军人事务糖尿病试验（VADT）。在这两项试验中，计算了收缩压（SBP）和舒张压（DBP）的变异系数（CV）和平均真实变异性（ARV），以及最大和累积平均 SBP 和 DBP。
在 ACCORD 中，SBP 和 DBP 的 CV 和 ARV 与 HF 风险增加相关，即使在调整了其他危险因素和平均血压后也是如此（例如，CV-SBP：风险比[HR]1.15， = 0.01；CV-DBP：HR 1.18， = 0.003）。在 VADT 中，DBP 变异性与 HF 风险增加相关（ARV-DBP：HR 1.16， = 0.001；CV-DBP：HR 1.09， = 0.04）。此外，在 ACCORD 中，基线血压逐渐降低的患者随着 CV-SBP、ARV-SBP 和 CV-DBP 的升高，HF 风险呈逐步增加。血压变异性的影响与血压下降有关，而不是升高。
在 2 型糖尿病患者中，血压变异性与 HF 风险相关，这可能是舒张期缺血的结果。这些结果可能对优化 2 型糖尿病患者的血压治疗策略具有重要意义。
