Effects of Visit-to-Visit Variability in Systolic Blood Pressure on Macrovascular and Microvascular Complications in Patient with Type 2 Diabetes: The ADVANCE Trial
Background—Recent evidence suggests visit-to-visit variability in systolic blood pressure (SBP) and maximum SBP are predictors of cardiovascular disease. However, it remains uncertain whether these parameters predict the risks of macrovascular and microvascular complications in patients with type 2 diabetes.
Methods and Results—ADVANCE was a factorial randomized controlled trial of blood pressure lowering and blood glucose control in patients with type 2 diabetes. The present analysis included 8811 patients without major macrovascular and microvascular events or death during the first 24 months after randomization. SBP variability (defined as standard deviation [SD]) and maximum SBP were determined during the first 24 months after randomization. During a median 2.4 years of follow-up from the 24-month visit, 407 major macrovascular (myocardial infarction, stroke or cardiovascular death) and 476 microvascular (new or worsening nephropathy or retinopathy) events were observed. The association of major macrovascular and microvascular events with SD SBP was continuous even after adjustment for mean SBP and other confounding factors (both P <0.05 for trend). Hazard ratios (95% confidence intervals) for the highest tenth of SD SBP were 1.54 (0.99-2.39) for macrovascular events and 1.84 (1.19-2.84) for microvascular events compared to the lowest tenth. For maximum SBP, hazard ratios (95% confidence intervals) for the highest tenth were 3.64 (1.73-7.66) and 2.18 (1.04-4.58), respectively.
Conclusions—Visit-to-visit variability in SBP and maximum SBP were independent risk factors for macrovascular and microvascular complications in type 2 diabetes.
Clinical Trial Registration Information—http://www.clinicaltrials.gov. Unique Identifier: NCT00145925.
- Received March 19, 2013.
- Revision received July 9, 2013.
- Accepted July 30, 2013.