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Blood pressure variability linked to CV outcomes in diabetes

By Colin Kenny, Editor – Diabetes Distilled
Blood pressure variability (BPV) is considered a novel risk factor for cardiovascular disease, as clinical trials have confirmed that short- and long-term variations in blood pressure (BP) independently contribute to target organ damage, cardiovascular events and mortality. In this systematic review and meta-analysis, investigators examined the relationship between BPV and all-cause mortality, major adverse cardiovascular events (MACEs), microvascular complications and organ damage in type 2 diabetes. They found that in adults with type 2 diabetes, systolic BPV was associated with adverse outcomes and concluded that variation in BP provided information beyond mean BP on the risk of cardiovascular disease in these individuals.

The protective effects of antihypertensive therapy in people with diabetes and high BP have been established in clinical practice. In this research, investigators performed a systematic review and meta-analysis of studies including patients with type 2 diabetes, at least one variable of BPV, and an evaluation of the incidence of at least one of the following outcomes: 

  • All-cause mortality
  • MACEs
  • Microvascular disease
  • Hypertension-mediated organ damage.

They identified 26 papers including data from a total of 377,305 individuals with diabetes. They analysed these papers for various outcomes and found that long-term systolic BPV is associated with an increased risk of all-cause mortality, MACEs, extended MACEs and microvascular disease in this high-risk population, independent of mean BP values. The observed associations between BPV and MACEs were also independent of mean BP, glycaemic control and serum creatinine levels. By contrast, long- and short-term diastolic BPV did not have the same predictive role, although the number of studies exploring the association between diastolic BPV and these outcomes was limited.

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