Effects of visit-to-visit variability in systolic blood pressure on macrovascular and microvascular complications in patients with type 2 diabetes mellitus: the ADVANCE trial.
BACKGROUND
Recent evidence suggests that 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 mellitus.


RESULTS
The Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) was a factorial randomized controlled trial of blood pressure lowering and blood glucose control in patients with type 2 diabetes mellitus. 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) 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 SBP variability 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 SBP variability were 1.54 (0.99-2.39) for macrovascular events and 1.84 (1.19-2.84) for microvascular events in comparison with 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 mellitus.


BACKGROUND
http://www.clinicaltrials.gov.
From The George Institute for Global Health, University of Sydney, Sydney, Australia (J.H., H.A., M.W., S.Z., C.A., A.P., B.N., S.M., J.C.); University of Oxford, Oxford, United Kingdom (P.M.R., S.M.); School of Public Health, Monash University, Clayton, Australia (S.Z.); Bond University, Gold Coast, Australia (P.G.); Université de Montréal, Montreal, Canada (P.H.); University of Milan-Bicocca, Milan, Italy (G.M.); Imperial College, London, United Kingdom (N.P.); and University College London (UCL) and the National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, United Kingdom (B.W.).
Jun
J
Hata
Hisatomi
H
Arima
Peter M
PM
Rothwell
Mark
M
Woodward
Sophia
S
Zoungas
Craig
C
Anderson
Anushka
A
Patel
Bruce
B
Neal
Paul
P
Glasziou
Pavel
P
Hamet
Giuseppe
G
Mancia
Neil
N
Poulter
Bryan
B
Williams
Stephen
S
Macmahon
John
J
Chalmers
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000502:physiology*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology; D003925:Diabetic Angiopathies / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D008833:Microcirculation / Q000502:physiology; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors
D000959:Antihypertensive Agents; D007004:Hypoglycemic Agents
blood pressure; diabetes mellitus, type 2; diabetic nephropathies; myocardial infarction; stroke