title: Systolic blood pressure variability and lower extremity amputation in a non-elderly population with diabetes.
abstract: OBJECTIVE
  Systolic blood pressure (SBP) variability is emerging as a new risk factor for cardiovascular diseases, diabetic nephropathy, and other atherosclerotic conditions. Our objective is to examine whether it has any prognostic value for lower-extremity amputations.
  
  
  METHODS
  This is a nested case-control study of a cohort of patients with diabetes aged<60 years and treated in the US Department of Veterans Healthcare system in 2003. They were followed over five years for any above-ankle (major) amputations. For each case with a major amputation (event), we randomly selected up to five matched controls based on age, sex, race/ethnicity, and calendar time. SBP variability was computed using three or more blood pressure measures taken during the one-year period before the event. Patients were classified into quartiles according to their SBP variability.
  
  
  RESULTS
  The study sample included 1038 cases and 2932 controls. Compared to Quartile 1 (lowest variability), Quartile 2 had 1.4 times (OR=1.44, 95% CI=1.00-2.07) and Quartiles 3 and 4 (highest) had 2.5 times (OR for Quartile 3=2.62, 95% CI=1.85-3.72; OR for Quartile 4=2.50, 95% CI=1.74-3.59) higher risk of major amputation (P for trend<0.001). This gradient relationship held in both normotensive and hypertensive groups as well as for individuals without prior peripheral vascular disease.
  
  
  CONCLUSIONS
  This is the first study to show a significant graded relationship between SBP variability and risk of major amputation among non-elderly persons with diabetes.
authors.affiliation: Hines VA Hospital, 5000 South 5th Avenue, Hines, IL 60141, USA; Stritch School of Medicine, Loyola University Chicago, 2160 South 1st Avenue, Maywood, IL 60153, USA.
authors.forename: Elly
authors.initials: E
authors.lastname: Budiman-Mak
authors.affiliation: Hines VA Hospital, 5000 South 5th Avenue, Hines, IL 60141, USA.
authors.forename: Noam
authors.initials: N
authors.lastname: Epstein
authors.affiliation: Middleton VA Medical Center, 2500 Overlook Terrace, Madison, WI 53705, USA; School of Medicine and Public Health, University of Wisconsin, 750 Highland Avenue, Madison, WI 53726, USA.
authors.forename: Meghan
authors.initials: M
authors.lastname: Brennan
authors.affiliation: Hines VA Hospital, 5000 South 5th Avenue, Hines, IL 60141, USA; Stritch School of Medicine, Loyola University Chicago, 2160 South 1st Avenue, Maywood, IL 60153, USA.
authors.forename: Rodney
authors.initials: R
authors.lastname: Stuck
authors.affiliation: Hines VA Hospital, 5000 South 5th Avenue, Hines, IL 60141, USA; Department of Physical Medicine and Rehabilitation and Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: Marylou
authors.initials: M
authors.lastname: Guihan
authors.affiliation: Hines VA Hospital, 5000 South 5th Avenue, Hines, IL 60141, USA.
authors.forename: Zhiping
authors.initials: Z
authors.lastname: Huo
authors.affiliation: Hines VA Hospital, 5000 South 5th Avenue, Hines, IL 60141, USA; Stritch School of Medicine, Loyola University Chicago, 2160 South 1st Avenue, Maywood, IL 60153, USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Emanuele
authors.affiliation: Department of Public Health Sciences, University of Virginia School of Medicine, Hospital West, 3rd Floor, RM 3181, Charlottesville, VA 22908, USA. Electronic address: msohn@virginia.edu.
authors.forename: Min-Woong
authors.initials: MW
authors.lastname: Sohn
mesh_terms: D000671:Amputation, Surgical; D001794:Blood Pressure; D001795:Blood Pressure Determination; D016022:Case-Control Studies; D003920:Diabetes Mellitus / Q000503:physiopathology*; D017719:Diabetic Foot / Q000209:etiology / Q000601:surgery*; D005006:Ethnicity; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications*; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D014728:Veterans
keywords: Diabetic complication; Lower-extremity amputation; Systolic blood pressure
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