Impact of BP variability on mortality and cardiovascular events in T2DM patients

  • Chiriacò M & al.
  • Diabetes Obes Metab
  • 7 Jul 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • In patients with type 2 diabetes mellitus (T2DM), long-term systolic blood pressure (SBP) variability is associated with an increased risk for all-cause mortality, major adverse cardiovascular events (MACEs), extended MACEs and microvascular complications (MiCs) independent of mean BP values.

Why this matters

  • Current guidelines consider only the absolute value of BP as a tool to classify the patient’s cardiovascular (CV) risk.
  • Findings suggest that BP variability may help in correct stratification of CV disease risk in patients with T2DM.

Study design

  • 26 studies involving 377,305 participants met eligibility criteria after a search across electronic databases.
  • Primary outcomes: all-cause mortality, MACEs (CV death, non-fatal myocardial infarction [MI] and non-fatal stroke), extended MACEs (CV death, non-fatal MI, fatal and non-fatal stroke and peripheral arterial disease) and MiC.
  • Funding: None disclosed.

Key results

  • After adjustment for confounders, the pooled HR for 1-SD increase in long-term SBP variability for Bayesian analysis, Hartung and Knapp correction and Paule-Mandel estimator, respectively, was:
    • all-cause mortality:
      • 1.12 (95% CI, 0.98-1.29),
      • 1.12 (95% CI, 1.01-1.24) and
      • 1.12 (95% CI, 1.04-1.21).
    • MACEs:
      • 1.10 (95% CI, 1.02-1.21),
      • 1.10 (95% CI, 1.01-1.19) and
      • 1.10 (95% CI, 1.04-1.17).
    • extended MACEs:
      • 1.08 (95% CI, 1.02-1.14),
      • 1.07 (95% CI, 1.03-1.12) and
      • 1.07 (95% CI, 1.03-1.11).
    • MiC:
      • 1.09 (95% CI, 1.01-1.23),
      • 1.12 (95% CI, 0.99-1.27) and
      • 1.12 (95% CI, 1.01-1.24).
  • No significant association was observed between diastolic BP variability and risk for all-cause mortality, MACEs, extended MACEs and MiC.

Limitations

  • Heterogeneity among studies.
  • No standard way to measure BP variability.