Visit-to-visit systolic blood pressure variability and microvascular complications among patients with diabetes

J Diabetes Complications. 2017 Jan;31(1):195-201. doi: 10.1016/j.jdiacomp.2016.09.003. Epub 2016 Sep 14.


Aims: To examine the relationship between systolic blood pressure (SBP) variability and the risk of microvascular complications in a non-elderly diabetic population.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Blood pressure variability; Microvascular complications; Nephropathy; Neuropathy; Retinopathy.

Publication types

  • Observational Study
  • Research Support, U.S. Gov't, P.H.S.
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Antihypertensive Agents / therapeutic use
  • Blood Pressure / drug effects
  • Cohort Studies
  • Diabetic Angiopathies / blood
  • Diabetic Angiopathies / complications*
  • Diabetic Angiopathies / drug therapy
  • Diabetic Angiopathies / physiopathology
  • Diabetic Nephropathies / complications*
  • Diabetic Nephropathies / epidemiology
  • Diabetic Neuropathies / complications*
  • Diabetic Neuropathies / epidemiology
  • Diabetic Retinopathy / complications*
  • Diabetic Retinopathy / epidemiology
  • Female
  • Follow-Up Studies
  • Glycated Hemoglobin / analysis
  • Hospitals, Veterans
  • Humans
  • Hypertension / blood
  • Hypertension / complications*
  • Hypertension / drug therapy
  • Hypertension / physiopathology
  • Incidence
  • Male
  • Microvessels / drug effects
  • Microvessels / physiopathology
  • Middle Aged
  • Retrospective Studies
  • Risk
  • United States / epidemiology


  • Antihypertensive Agents
  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human