Association between blood pressure variability, cardiovascular disease and mortality in type 2 diabetes: A systematic review and meta‐analysis

Abstract

Aim 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. Materials and methods PubMed, Medline, Embase, Cinahl, Web of Science, http://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. Results 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. Conclusions 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.

Rotundic Acid Protects against Metabolic Disturbance and Improves Gut Microbiota in Type 2 Diabetes Rats

“…The development of T2D results mostly from obesity, which is associated with a high-calorie dietary style and other unhealthy living habits [4]. In particular, T2D induces severe metabolic disorders and vascular diseases, such as hyperlipemia, 2 of 17 hypertension, and cardiovascular and cerebrovascular diseases, which together contribute to high rates of morbidity and mortality [5].…”

Age-specific associations of blood pressure variability with cardiovascular disease and mortality: 10-year Diabetes cohort study

“…A recent systematic review found a relationship between long-term SBP variability and higher risks for CVD and mortality in diabetic population (10). However, only six and five studies included in the review for the CVD and mortality outcome, respectively.…”

Comparison of day‐to‐day blood pressure variability in hypertensive patients with type 2 diabetes mellitus to those without diabetes: Asia BP@Home Study

“…Type 2 diabetes mellitus (T2DM) has been shown to be associated with an increased risk of CV mortality and morbidity when compared to individuals without diabetes and to be independently associated with increased CV morbidity and mortality . Hypertension has also been shown to be associated with greater BPV .…”

“…Hypertension has also been shown to be associated with greater BPV . In the presence of diabetes in patients with hypertension, it is not surprising nor unexpected that CV morbidity and mortality will be further increased compared to patients with hypertension but without diabetes …”

“…Most of the studies on BPV in diabetic patients with hypertension examined short‐term BPV using ambulatory blood pressure measurements (ABPM), and indeed, CV morbidity and mortality as well as diabetic nephropathy and macro‐albuminuria are increased compared to those diabetic patients without hypertension . However, not many studies have been done to examine mid‐term BPV using home BP measurement (HBPM) in hypertensive patients with diabetes and directly compared them to those hypertensives without diabetes.…”