Visit-to-visit systolic blood pressure variability and microvascular complications among patients with diabetes

Abstract

Aims To examine the relationship between systolic blood pressure (SBP) variability and the risk of microvascular complications in a non-elderly diabetic population. Methods This is a retrospective cohort study of individuals aged ≤60 years treated for diabetes in 2003 in the US Department of Veterans Affairs healthcare system. Individuals were followed for five years for any new diagnosis of diabetic nephropathy, retinopathy, or neuropathy. In each year of follow-up, individuals were classified into quartiles based on their SBP variability. Results We identified 208,338 patients with diabetes without diabetic nephropathy, retinopathy, or neuropathy at baseline. Compared to individuals with the least SBP variability (Quartile 1), those with most variability (Quartile 4) had 81% (OR = 1.81; 95% CI, 1.72–1.91), 17% (OR = 1.17; 95% CI, 1.13–1.21), 30% (OR = 1.30; 95% CI, 1.25–1.35), and 19% (OR = 1.19; 95% CI, 1.15–1.23) higher incidence of nephropathy, retinopathy, neuropathy, and any complication, respectively, after adjusting for mean SBP, demographic and clinical factors. Conclusions We found a significant graded relationship between SBP variability and the incidence of each complication and of any combined endpoint. This is the first study showing a significant association between SBP variability and the risk of diabetic retinopathy and neuropathy.

Increasing SBP variability is associated with an increased risk of developing incident diabetic foot ulcers

“…SBP variability has also been associated with increased risk of microvascular complications, such as nephropathy and retinopathy [5,6]. Underlying macrovas-cular and microvascular diseases are dominant risk factors for development of a diabetic foot ulcer; therefore, our finding that excessive SBP variability is associated with an increased risk in foot ulceration is consistent with prior knowledge.…”

“…Excessive SBP variability may offer a potential new target for mitigating end-organ damage associated with microvascular and macrovascular disease, such as diabetic foot ulcers [1—6]. Foot ulcers typically arise whenever a minor injury goes unnoticed because of peripheral neuropathy (a microvascular complication) and fails to heal because of limb ischemia (a macrovascular complication) [7,8].…”

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

“…Full‐text versions of the remaining 73 articles were retrieved and singularly examined. Ultimately, 47 studies were excluded and, of the remaining 26 papers that were included, 22 were selected for quantitative analysis . Secondary endpoints (i.e.…”

Visit‐to‐visit HbA1c variability and systolic blood pressure (SBP) variability are significantly and additively associated with mortality in individuals with type 1 diabetes: An observational study

“…Median (interquartile range [IQR]) number of HbA1c measurements was 4 . Median (IQR) number of SBP measurements was 5 Median HbA1c (IQR) was 71 (62‐83) mmol/mol, and median (IQR) SBP was 129 (120‐138) mm Hg. Median HbA1c CV was 8.0, and median SBP CV was 8.1.…”

“…Variability in BP is also thought to be clinically significant. Variability between visit‐to‐visit readings in SBP has been shown to confer an increased rate of microvascular complications in both type 1 and type 2 diabetes, and an increased risk of cardiovascular events and mortality in type 2 diabetes …”