Visit-to-visit variability in systolic blood pressure 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.
References (22)
- et al.
Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension
Lancet
(2010) - et al.
Rationale and usefulness of newly devised abbreviated diagnostic criteria and staging for diabetic polyneuropathy
Diabetes Res Clin Pract
(2007) - et al.
Stroke
Lancet
(2003) - et al.
International Society of Hypertension: global burden of blood-pressure-related disease, 2001
Lancet
(2008) - et al.
Visit-to-visit blood pressure variations: new independent determinants for carotid artery measures in the elderly at high risk of cardiovascular disease
J Am Soc Hypertens
(2011) - et al.
Effects of antihypertensive-drug class on interindividual variation in blood pressure and risk of stroke: a systematic review and meta-analysis
Lancet
(2010) - et al.
Cardiovascular morbidity and mortality associated with the metabolic syndrome
Diabetes Care
(2001) Multiple risk factor intervention trial. Risk factor changes and mortality results
JAMA
(1982)- et al.
Estimated glomerular filtration rate and albuminuria are independent predictors of cardiovascular events and death in type 2 diabetes mellitus: the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study
Diabetologia
(2011) - et al.
The association of microalbuminuria and mortality in non-insulin-dependent diabetes mellitus. A systematic overview of the literature
Arch Intern Med
(1997)
Report of the expert committee on the diagnosis and classification of diabetes mellitus
Diabetes Care
Cited by (113)
Effect of the variability of blood pressure, glucose level, total cholesterol level, and body mass index on the risk of atrial fibrillation in a healthy population
2020, Heart RhythmCitation Excerpt :First, the high variability of BP could be an indicator for the higher chance that BP is not within the optimal therapeutic range.13 In addition, visit-to-visit BP variability indicated impaired vascular function and led to blood vessel damage and endothelial dysfunction.5,17–19 In lipid variability, endothelial dysfunction could be a mediator predisposing to AF development.14,20,21
Deregulated Long Non-Coding RNA HCG11 in Cerebral Atherosclerosis Serves as a Biomarker to Predict the Risk of Cerebrovascular Events
2023, Clinical and Applied Thrombosis/HemostasisMean arterial pressure trajectory with premature cardiovascular disease and all-cause mortality in young adults: the Kailuan prospective cohort study
2023, Frontiers in Cardiovascular MedicineCardiovascular variability, sociodemographics, and biomarkers of disease: the MIDUS study
2023, Frontiers in Physiology