title: Blood pressure trajectories prior to death in patients with diabetes.
abstract: OBJECTIVE
  The goals of this study were to examine trajectories of blood pressure (BP) in adults with diabetes and investigate the association of trajectory patterns with mortality.
  
  
  METHODS
  A nonconcurrent longitudinal design was used to monitor 3,766 Medicare patients with diabetes from 2005 through 2008. Data were extracted from a registry of Medicare beneficiaries, which was developed by a large academic practice that participated in the Physician Group Practice Medicare Demonstration. The relationship between BP trajectories and all-cause mortality was modeled using multilevel mixed-effects linear regression.
  
  
  RESULTS
  During the 4-year study period, 10.7% of the patients died, half of whom were aged≥75 years. The crude and adjusted models both showed a greater decline in systolic and diastolic BP in patients who died than in those who did not die. In a model adjusted for age, sex, race, medications, and comorbidities, the mean systolic BP decreased by 3.2 mmHg/year (P<0.001) in the years before death and by 0.7 mmHg/year (P<0.001) in those who did not die (P<0.001 for the difference in slopes). Similarly, diastolic BP declined by 1.3 mmHg/year for those who died (P<0.001) and by 0.6 mmHg/year for those who did not die (P<0.001); the difference in slopes was significant (P=0.021).
  
  
  CONCLUSIONS
  Systolic and diastolic BP both declined more rapidly in the 4 years before death than in patients who remained alive.
authors.affiliation: Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA. maryroge@umich.edu
authors.forename: Mary A M
authors.initials: MA
authors.lastname: Rogers
authors.forename: Kathleen
authors.initials: K
authors.lastname: Ward
authors.forename: Tanya R
authors.initials: TR
authors.lastname: Gure
authors.forename: Hae M
authors.initials: HM
authors.lastname: Choe
authors.forename: Pearl G
authors.initials: PG
authors.lastname: Lee
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Bernstein
authors.forename: Caroline S
authors.initials: CS
authors.lastname: Blaum
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000401:mortality* / Q000503:physiopathology; D003971:Diastole; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D006278:Medicare; D008875:Middle Aged; D012042:Registries; D013599:Systole; D014481:United States / Q000453:epidemiology