title: Relationships between the risk of cardiovascular disease in type 2 diabetes patients and both visit-to-visit variability and time-to-effect differences in blood pressure.
abstract: OBJECTIVE
  To determine whether visit-to-visit blood pressure (BP) variability can predict cardiovascular disease (CVD) incidence in type 2 diabetes patients independently of mean BP, and to analyze the time-to-effect relationship between BP and CVD risk.
  
  
  METHODS
  We retrospectively enrolled 629 type 2 diabetes patients with no history of CVD who first visited our hospital between 1995 and 1996, made at least one hospital visit per year, were followed-up for at least 1 year, and had undergone four or more BP measurements. The patients were followed until June 2012 at the latest.
  
  
  RESULTS
  CVD occurred in 66 patients. Variability in systolic or diastolic BP (SBP and DBP, respectively) was a significant predictor of CVD incidence, independent of mean SBP or DBP. CVD incidence was significantly associated with SBP during the preceding 3-5 years, with the highest risk occurring during the preceding 3 years.
  
  
  CONCLUSIONS
  Visit-to-visit BP variability independently predicts CVD incidence in type 2 diabetes patients. Increased SBP over the preceding 3-5 years indicated a significant CVD risk. To prevent CVD, BP management should focus on stable and well-timed control. In particular, BP stabilization at an early phase and BP control during late phases are important.
authors: Division of Diabetes and Metabolism, 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: Division of Diabetes and Metabolism, The Institute for Adult Diseases, Asahi Life Foundation, Tokyo, Japan.
authors: Kumiko
authors: K
authors: Kimura
authors: Department of Public Health and Environmental Medicine, The Jikei University School of Medicine, Tokyo, Japan.
authors: Machi
authors: M
authors: Suka
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 Metabolism, The Institute for Adult Diseases, Asahi Life Foundation, Tokyo, Japan.
authors: Masatoshi
authors: M
authors: Kikuchi
authors: Division of Diabetes and Metabolism, The Institute for Adult Diseases, Asahi Life Foundation, Tokyo, Japan.
authors: Shoji
authors: S
authors: Kawazu
authors: Department of Biostatistics, School of Public Health, University of Tokyo, Tokyo, Japan.
authors: Yutaka
authors: Y
authors: Matsuyama
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000150:complications* / Q000453:epidemiology / Q000517:prevention & control; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy; D003925:Diabetic Angiopathies / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D058065:Diabetic Cardiomyopathies / Q000453:epidemiology* / Q000517:prevention & control; D016903:Drug Monitoring; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D057285:Precision Medicine; D058246:Prehypertension / Q000150:complications / Q000188:drug therapy*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012306:Risk
chemical_list: D000959:Antihypertensive Agents; D007004:Hypoglycemic Agents
keywords: Blood pressure; Cardiovascular disease; Time-to-effect differences; Type 2 diabetes; Visit-to-visit variability