• Eur. J. Clin. Invest. · Mar 2012

    Visit-to-visit variability in blood pressure strongly predicts all-cause mortality in patients with type 2 diabetes: a 5·5-year prospective analysis.

    • Yi-Ting Hsieh, Shih-Te Tu, Tzu-Jung Cho, Shun-Jen Chang, Jung-Fu Chen, and Ming-Chia Hsieh.
    • Department of Ophthalmology, Buddhist Tzu Chi General Hospital, Taipei Branch, Taipei, Taiwan.
    • Eur. J. Clin. Invest. 2012 Mar 1; 42 (3): 245-53.

    BackgroundElevations in blood pressure and visit-to-visit variability have been found to significantly increase the risk of cardiovascular morbidity and mortality in nondiabetic individuals. This study has assessed the association between all-cause mortality and blood pressure parameters [systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), mean arterial pressure (MAP) and visit-to-visit variability] in patients with type 2 diabetes.Materials And MethodsA longitudinal cohort study of 2161 patients with type 2 diabetes and a mean follow-up period of 66·7 ± 7·5 months. Using Cox regression models, blood pressure parameters were related to the risk of all-cause mortality.ResultsVisit-to-visit variability in SBP [HR: 1·048 (95% CI: 1·005-1·092; P = 0·03)], DBP [HR: 1·090 (95% CI: 1·021-1·163; P = 0·01)] and MAP [HR: 1·099 (95% CI: 1·033-1·170; P = 0·003)] significantly predicted all-cause mortality in patients with type 2 diabetes after adjusting for baseline data, mean follow-up blood pressure profiles and HbA1c. Visit-to-visit variability in PP [HR: 1·139 (95% CI: 1·030-1·258; P = 0·01)] significantly predicted cardiovascular mortality. Neither baseline nor follow-up SBP, DBP, PP nor MAP was significantly associated with all-cause and cardiovascular mortality after adjusting for blood pressure variability. The risk of all-cause mortality with a mean follow-up SBP has a U-shaped distribution. Patients with a mean follow-up DBP > 90 mmHg were at higher risk of mortality than those with DBP < 90 mmHg.ConclusionsVisit-to-visit variability in blood pressure was significantly associated with all-cause mortality independent of mean BP in patients with type 2 diabetes. The data for blood pressure variability might be regarded as a potentially important therapeutic target in the management of type 2 diabetes.© 2011 The Authors. European Journal of Clinical Investigation © 2011 Stichting European Society for Clinical Investigation Journal Foundation.

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