Department of Medicine, University of Maryland Medical Center, Baltimore, Maryland, USA.
Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Am J Hypertens. 2021 Aug 9;34(7):689-697. doi: 10.1093/ajh/hpaa210.
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.
我们评估了 2 型糖尿病患者的随访期间血压（BP）变异性与心血管疾病（CVD）事件和死亡的相关性。
我们分析了 Look AHEAD（糖尿病患者的健康行动）研究中的 4152 名参与者，这些参与者在随访的前 36 个月内没有发生 CVD 事件和死亡。通过个体内标准差、均值独立的变异和变异系数评估了 4 次年度访视的收缩压（SBP）和舒张压（DBP）的变异性。使用 Cox 回归生成 CVD（心肌梗死[MI]、卒中和与 CVD 相关的死亡）和死亡率的调整后的危险比（aHR）和 95%置信区间（CI）。
中位随访时间为 6.6 年，发生了 220 例 MI、105 例卒中和 62 例与 CVD 相关的死亡以及 236 例死亡。在校正包括平均 BP 在内的混杂因素后，SBP 标准差最高（vs. 最低）三分位的 aHR 分别为 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）和 1.64（95%CI 0.99-2.72），分别用于 CVD 死亡率、全因死亡率、CVD、MI 和卒中等结局。DBP 标准差的等效 aHR 分别为 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）和 0.97（95%CI 0.58-1.60）。
在 2 型糖尿病患者的大样本中，SBP 变异性增加与心血管死亡率和 CVD 事件增加相关；DBP 变异性增加与全因和心血管死亡率增加相关。
