Elsevier

Atherosclerosis

Volume 220, Issue 1, January 2012, Pages 155-159
Atherosclerosis

Visit-to-visit variability in systolic blood pressure is correlated with diabetic nephropathy and atherosclerosis in patients with type 2 diabetes

https://doi.org/10.1016/j.atherosclerosis.2011.10.033Get rights and content

Abstract

Objective

Recent studies make remarks on the effect of variability in systolic blood pressure (SBP) on the development of cardiovascular disease. The aim of this study was to investigate the relationship between the variability in SBP and the degree of diabetic nephropathy and atherosclerosis in patients with type 2 diabetes.

Methods

We measured SBP in 422 consecutive patients with type 2 diabetes at every visit during a year, and we calculated the coefficient of variation (CV) of SBP. Then, we evaluated relationships of variability of SBP to degree of urinary albumin excretion (UAE), which is a useful marker for cardiovascular disease as well as diabetic nephropathy, ankle-brachial index (ABI) and pulse wave velocity (PWV).

Results

CV of SBP positively correlated with log UAE (r = 0.210, P < 0.0001) or PWV (r = 0.409, P < 0.0001), whereas CV of SBP inversely correlated with ABI (r = −0.098, P = 0.0463). Multiple regression analysis demonstrated that CV of SBP independently correlated with log UAE (β = 0.149, P = 0.0072), PWV (β = 0.337, P < 0.0001) or ABI (β = −0.162, P = 0.0101).

Conclusions

Not only average SBP but also variability in SBP is correlated with diabetic nephropathy and atherosclerosis in patients with type 2 diabetes.

Introduction

Cardiovascular disease (CVD) is the primary cause of mortality and morbidity in patients with type 2 diabetes, and several risk factors including smoking, hypertension and dyslipidemia have been shown to accelerate the progression of CVD [1], [2]. Elevated albumin excretion rate, which is a useful marker for diabetic nephropathy, has been reported to be associated with increased risk of cardiovascular mortality and the progression of CVD [3], [4]. Recently, it is suggested that not only average blood pressure but also variability in blood pressure may relate to CVD [5]. Although it is widely known that average blood pressure is related to albuminuria, the relationship between the variability in blood pressure and albuminuria has not been investigated. Therefore, we evaluated the relationship between the variability in blood pressure and the degree of the urinary albumin excretion (UAE) as well as markers of subclinical atherosclerosis such as ankle-brachial index (ABI) or pulse wave velocity (PWV) in patients with type 2 diabetes.

Section snippets

Patients and study design

We measured blood pressure at every visit during a year in 422 consecutive patients with type 2 diabetes recruited from the outpatient clinic at the Kyoto Prefectural University of Medicine. Type 2 diabetes was diagnosed according to the Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus [6]. Body mass index (BMI) was calculated as weight in kilograms divided by height in meters squared. Patients were classified as nonsmokers, past smokers, or current

Results

Characteristics of the 422 patients with diabetes enrolled in this study are shown in Table 1. The average number of measurements per subject during the year of data collection was 7.15 ± 2.00. Mean CV of SBP was 8.1 ± 4.0%. There were 105 patients (24.9%) with estimated glomerular filtration rate <60 mL/min/1.73 m2 at baseline. Relationships between CV of SBP and other variables are shown in Table 2. No significant correlations were found between CV of SBP and average SBP, heart rate, hemoglobin

Discussion

We evaluated relationships between visit-to-visit variability in SBP and degree of UAE as well as markers of subclinical atherosclerosis in patients with type 2 diabetes. Positive correlation was found between variability in SBP and log UAE or PWV, and inverse correlation was found between variability in SBP and ABI. Multiple regression analysis also demonstrated that variability in SBP independently correlated with log UAE, PWV and ABI.

Although previous studies have found that average SBP is an

Conclusion

Not only average SBP but also variability in SBP is correlated with diabetic nephropathy and subclinical atherosclerosis in patients with type 2 diabetes.

Conflict of interest

There are no conflicts of interest.

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  • Cited by (0)

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