Visit-to-visit variability in blood pressure strongly predicts all-cause mortality in patients with type 2 diabetes: a 5·5-year prospective analysis

Eur J Clin Invest. 2012 Mar;42(3):245-53. doi: 10.1111/j.1365-2362.2011.02574.x. Epub 2011 Aug 5.


Background: Elevations in blood pressure and visit-to-visit variability have been found to significantly increase the risk of cardiovascular morbidity and mortality in nondiabetic individuals. This study has assessed the association between all-cause mortality and blood pressure parameters [systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), mean arterial pressure (MAP) and visit-to-visit variability] in patients with type 2 diabetes.

Materials and methods: A longitudinal cohort study of 2161 patients with type 2 diabetes and a mean follow-up period of 66·7 ± 7·5 months. Using Cox regression models, blood pressure parameters were related to the risk of all-cause mortality.

Results: Visit-to-visit variability in SBP [HR: 1·048 (95% CI: 1·005-1·092; P = 0·03)], DBP [HR: 1·090 (95% CI: 1·021-1·163; P = 0·01)] and MAP [HR: 1·099 (95% CI: 1·033-1·170; P = 0·003)] significantly predicted all-cause mortality in patients with type 2 diabetes after adjusting for baseline data, mean follow-up blood pressure profiles and HbA1c. Visit-to-visit variability in PP [HR: 1·139 (95% CI: 1·030-1·258; P = 0·01)] significantly predicted cardiovascular mortality. Neither baseline nor follow-up SBP, DBP, PP nor MAP was significantly associated with all-cause and cardiovascular mortality after adjusting for blood pressure variability. The risk of all-cause mortality with a mean follow-up SBP has a U-shaped distribution. Patients with a mean follow-up DBP > 90 mmHg were at higher risk of mortality than those with DBP < 90 mmHg.

Conclusions: Visit-to-visit variability in blood pressure was significantly associated with all-cause mortality independent of mean BP in patients with type 2 diabetes. The data for blood pressure variability might be regarded as a potentially important therapeutic target in the management of type 2 diabetes.

MeSH terms

  • Aged
  • Asian Continental Ancestry Group
  • Blood Pressure Determination / methods
  • Blood Pressure*
  • Cardiovascular Diseases / mortality*
  • Cause of Death
  • Cohort Studies
  • Diabetes Mellitus, Type 2 / mortality*
  • Diabetes Mellitus, Type 2 / physiopathology
  • Female
  • Follow-Up Studies
  • Humans
  • Hypertension / mortality
  • Hypertension / physiopathology
  • Male
  • Middle Aged
  • Office Visits
  • Predictive Value of Tests
  • Proportional Hazards Models
  • Prospective Studies
  • Risk Assessment
  • Risk Factors
  • Time Factors