title: Visit-to-visit variability in systolic blood pressure predicts development and progression of diabetic nephropathy, but not retinopathy, in patients with type 2 diabetes.
abstract: OBJECTIVE
  To investigate whether visit-to-visit variability in systolic blood pressure (SBP) can predict development and progression of diabetic nephropathy and retinopathy in patients with type 2 diabetes mellitus (T2DM).
  
  
  METHODS
  From 1995 through 1996, 664 T2DM patients visited our hospital for the first time and were subsequently examined 4 times or more and at least once annually. At first visit, 326 had normoalbuminuria, 644 had an estimated glomerular filtration rate (eGFR) of ≥ 45 ml/min/1.73 m(2), 526 had no diabetic retinopathy and 609 had no severe non-proliferative diabetic retinopathy (NPDR). They were followed through June 2012, at the latest.
  
  
  RESULTS
  Ninety patients developed microalbuminuria, 76 showed decrease of eGFR to <45 ml/min/1.73 m(2), 113 developed mild-moderate NPDR and 50 progression to severe NPDR. The unadjusted, age- and sex-adjusted and multivariate-adjusted hazard ratios for development and progression of nephropathy, but not retinopathy, increased across tertiles of the standard deviation (SD) of SBP. Both the SD and coefficient of variation (CV) of SBP were significant predictors of development and progression of nephropathy, but not retinopathy, independently of mean SBP.
  
  
  CONCLUSIONS
  Visit-to-visit SBP variability is an independent predictor of development and progression of diabetic nephropathy, but not retinopathy, in T2DM patients.
authors: Division of Diabetes and Metabolic Diseases, The Institute for Adult Diseases, Asahi Life Foundation, Tokyo, Japan. Electronic address: t-takao@asahi-life.or.jp.
authors: Toshiko
authors: T
authors: Takao
authors: Department of Biostatistics, School of Public Health, University of Tokyo, Tokyo, Japan.
authors: Yutaka
authors: Y
authors: Matsuyama
authors: Department of Public Health and Environmental Medicine, the Jikei University School of Medicine, Tokyo, Japan.
authors: Hiroyuki
authors: H
authors: Yanagisawa
authors: Division of Diabetes and Metabolic Diseases, The Institute for Adult Diseases, Asahi Life Foundation, Tokyo, Japan.
authors: Masatoshi
authors: M
authors: Kikuchi
authors: Division of Diabetes and Metabolic Diseases, The Institute for Adult Diseases, Asahi Life Foundation, Tokyo, Japan.
authors: Shoji
authors: S
authors: Kawazu
mesh_terms: D000368:Aged; D001794:Blood Pressure; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology*; D003928:Diabetic Nephropathies / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology*; D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D009819:Office Visits / Q000706:statistics & numerical data*; D011379:Prognosis
keywords: Blood pressure variability; Nephropathy; Retinopathy; Systolic blood pressure; Type 2 diabetes