Visit-to-visit systolic blood pressure variability and microvascular complications among patients with diabetes.
To examine the relationship between systolic blood pressure (SBP) variability and the risk of microvascular complications in a non-elderly diabetic population.



This is a retrospective cohort study of individuals aged ≤60years treated for diabetes in 2003 in the US Department of Veterans Affairs healthcare system. Individuals were followed for five years for any new diagnosis of diabetic nephropathy, retinopathy, or neuropathy. In each year of follow-up, individuals were classified into quartiles based on their SBP variability.



We identified 208,338 patients with diabetes without diabetic nephropathy, retinopathy, or neuropathy at baseline. Compared to individuals with the least SBP variability (Quartile 1), those with most variability (Quartile 4) had 81% (OR=1.81; 95% CI, 1.72-1.91), 17% (OR=1.17; 95% CI, 1.13-1.21), 30% (OR=1.30; 95% CI, 1.25-1.35), and 19% (OR=1.19; 95% CI, 1.15-1.23) higher incidence of nephropathy, retinopathy, neuropathy, and any complication, respectively, after adjusting for mean SBP, demographic and clinical factors.



We found a significant graded relationship between SBP variability and the incidence of each complication and of any combined endpoint. This is the first study showing a significant association between SBP variability and the risk of diabetic retinopathy and neuropathy.
Department of Public Health Sciences, School of Medicine, University of Virginia, PO Box 800717, Charlottesville, VA 22908. Electronic address: msohn@virginia.edu.
Min-Woong
MW
Sohn
Medical and Research Services, Hines VA Hospital, 5000 South 5th Avenue, Hines, IL 60141.
Noam
N
Epstein
Department of Medicine, the University of Chicago, 924 East 57th Street, Chicago, IL 60637.
Elbert S
ES
Huang
Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, 5000 South 5th Avenue, Hines, IL 60141.
Zhiping
Z
Huo
Medical and Research Services, Hines VA Hospital, 5000 South 5th Avenue, Hines, IL 60141; Stritch School of Medicine, Loyola University Chicago, 2160 S 1st Avenue, Maywood, IL 60153.
Nicholas
N
Emanuele
Department of Public Health Sciences, School of Medicine, University of Virginia, PO Box 800717, Charlottesville, VA 22908.
George
G
Stukenborg
Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, 5000 South 5th Avenue, Hines, IL 60141; Department of Physical Medicine and Rehabilitation, Northwestern University, 710 North Lake Shore Drive #1022, Chicago, IL 60611.
Marylou
M
Guihan
Medical and Research Services, Hines VA Hospital, 5000 South 5th Avenue, Hines, IL 60141; Stritch School of Medicine, Loyola University Chicago, 2160 S 1st Avenue, Maywood, IL 60153.
Junping
J
Li
Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, 5000 South 5th Avenue, Hines, IL 60141; Stritch School of Medicine, Loyola University Chicago, 2160 S 1st Avenue, Maywood, IL 60153.
Elly
E
Budiman-Mak
D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D015331:Cohort Studies; D003925:Diabetic Angiopathies / Q000097:blood / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000150:complications* / Q000453:epidemiology; D003929:Diabetic Neuropathies / Q000150:complications* / Q000453:epidemiology; D003930:Diabetic Retinopathy / Q000150:complications* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006787:Hospitals, Veterans; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D015994:Incidence; D008297:Male; D055806:Microvessels / Q000187:drug effects / Q000503:physiopathology; D008875:Middle Aged; D012189:Retrospective Studies; D012306:Risk; D014481:United States / Q000453:epidemiology
D000959:Antihypertensive Agents; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
Blood pressure variability; Microvascular complications; Nephropathy; Neuropathy; Retinopathy
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