medwireNews: A post-hoc analysis of the ACCORD and VADT trials suggests that visit-to-visit variability in blood pressure (BP) is associated with an elevated risk for heart failure (HF) among people with type 2 diabetes.
The study, reported in Diabetes Care, included 9383 participants from ACCORD and 1550 from VADT who had no history of HF at baseline and were followed up for an average of approximately 5 years. Over this time, 313 people from the ACCORD trial and 102 from VADT experienced HF events.
“These trials have the advantage of frequent and carefully measured blood pressure assessments and adjudicated HF events, rendering them ideal cohorts” to assess the association between BP variability and HF risk, say Daniel Nuyujukian (University of Arizona, Tucson, USA) and fellow researchers.
The team describes a “strong, significant trend” of increasing risk for HF with increasing quartiles of variability in both systolic and diastolic BP (SBP and DBP, respectively) in the ACCORD trial.
In a fully adjusted model accounting for factors including cumulative mean BP, age, race/ethnicity, diabetes duration, BMI, and glycated hemoglobin, variability in SBP and DBP was associated with a significantly elevated HF risk, with hazard ratios (HRs) of 1.15 and 1.18, respectively, per standard deviation increase in variability measured by coefficient of variation (CV), and corresponding HRs of 1.19 and 1.18 when average real variability (ARV) was used to quantify variability.
The associations between DBP variability and HF risk were also seen in the VADT cohort, with an HR of 1.09 for CV-measured variability and 1.16 for ARV-measured variability. However, Nuyujukian and team say that the association between elevated SBP and HF risk did not reach statistical significance in the fully adjusted model, “possibly due to the smaller cohort size” for VADT.
The researchers also conducted a subgroup analysis of the ACCORD cohort in which patients were categorized based on baseline BP, finding that the association between BP variability and HF risk was strongest among those with the lowest baseline measurements. For instance, the HR for the association between CV-measured SPB variability and HF risk was a nonsignificant 1.03 for people with baseline SBP of 140 mmHg or higher, rising to a significant 1.21 for those with baseline SBP of less than 140 mmHg, and was highest, at 1.69, for participants with baseline SBP of less than 120 mmHg. There was a similar pattern of results for DBP.
They conclude that their findings “may support use of relatively easily accessible visit-to-visit blood pressure variability assessments to improve risk factor stratification and further individualization of blood pressure treatment strategies.”
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