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).
- all-cause mortality:
- 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.
References
References