Physicians' Academy for Cardiovascular Education

Addition of SBP variability improves risk stratification of diabetic patients

Prognostic Value of Variability in Systolic Blood Pressure Related to Vascular Events and Premature Death in Type 2 Diabetes Mellitus: The ADVANCE-ON Study

Ohkuma T, Woodward M, Jun M, et al. - Hypertension. 2017;70: published online ahead of print

Background

All CVD risk scores include a BP factor that is prone to visit-to-visit variability (VVV) [1,2]. Moreover, increased BP variability is a risk factor for macrovascular and microvascular events and death itself, independently of other CV risk factors [3].

In this analysis of the ADVANCE study, the long-term impact of SBP variability and its predictive ability for vascular complications and mortality was assessed, in T2DM patients. The primary outcome was the composite of MI, stroke, CV death, requirement for chronic renal-replacement therapy, death from renal disease or all-cause mortality.

Main results

Conclusion

In diabetic patients, the SBP visit-to-visit variability is an independent predictor of vascular complications and death, which improves the predictive ability of traditional risk factors, including mean SBP. These results support the use of SBP variability for individual risk stratification, and they suggest that the reduction of SBP variability may be an important therapeutic target in these patients.

References

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