Title

Effects of visit-to-visit variability in systolic blood pressure on macro vascular and micro vascular complications in patients with type 2 diabetes mellitus: The advance trial

Date of this Version

9-17-2013

Document Type

Journal Article

Publication Details

Citation only

Hata, J., Arima, H., Rothwell, P. M., Woodward, M., Zoungas, S., Anderson, C.,Patel, A., Neal, B., Glasziou, P., Hamet, P., Macia, G., Poulter, N., Williams, B., MacMahon, S., & Chalmers, J. (2013). Effects of visit-to-visit variability in systolic blood pressure on macro vascular and micro vascular complications in patients with type 2 diabetes mellitus: The advance trial. Circulation, 128(12), 1325-1334.

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© Copyright, American Heart Association, 2013

2013 HERDC submission. FoR Code: 111717;110399

NHMRC Project Grant 0527500

ISSN

0009-7322

Abstract

Recent evidence suggests that visit-to-visit variability in systolic blood pressure (SBP) and maximum SBP are predictors of cardiovascular disease. However, it remains uncertain whether these parameters predict the risks of macro vascular and micro vascular complications in patients with type 2 diabetes mellitus. METHODS AND RESULTS-: The Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) was a factorial randomized controlled trial of blood pressure lowering and blood glucose control in patients with type 2 diabetes mellitus. The present analysis included 8811 patients without major macrovascular and microvascular events or death during the first 24 months after randomization. SBP variability (defined as standard deviation) and maximum SBP were determined during the first 24 months after randomization. During a median 2.4 years of follow-up from the 24-month visit, 407 major macrovascular (myocardial infarction, stroke, or cardiovascular death) and 476 microvascular (new or worsening nephropathy or retinopathy) events were observed. The association of major macrovascular and microvascular events with SBP variability was continuous even after adjustment for mean SBP and other confounding factors (both P

 

This document has been peer reviewed.