Blood Pressure Variability and Risk of Heart Failure in ACCORD and the VADT
- 1 July 2020
- journal article
- research article
- Published by American Diabetes Association in Diabetes Care
- Vol. 43 (7), 1471-1478
- https://doi.org/10.2337/dc19-2540
Abstract
OBJECTIVE Although blood pressure variability is increasingly appreciated as a risk factor for cardiovascular disease, its relationship with heart failure (HF) is less clear. We examined the relationship between blood pressure variability and risk of HF in two cohorts of type 2 diabetes participating in trials of glucose and/or other risk factor management. RESEARCH DESIGN AND METHODS Data were drawn from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial and the Veterans Affairs Diabetes Trial (VADT). Coefficient of variation (CV) and average real variability (ARV) were calculated for systolic (SBP) and diastolic blood pressure (DBP) along with maximum and cumulative mean SBP and DBP during both trials. RESULTS In ACCORD, CV and ARV of SBP and DBP were associated with increased risk of HF, even after adjusting for other risk factors and mean blood pressure (e.g., CV-SBP: hazard ratio [HR] 1.15,P= 0.01; CV-DBP: HR 1.18,P= 0.003). In the VADT, DBP variability was associated with increased risk of HF (ARV-DBP: HR 1.16,P= 0.001; CV-DBP: HR 1.09,P= 0.04). Further, in ACCORD, those with progressively lower baseline blood pressure demonstrated a stepwise increase in risk of HF with higher CV-SBP, ARV-SBP, and CV-DBP. Effects of blood pressure variability were related to dips, not elevations, in blood pressure. CONCLUSIONS Blood pressure variability is associated with HF risk in individuals with type 2 diabetes, possibly a consequence of periods of ischemia during diastole. These results may have implications for optimizing blood pressure treatment strategies in those with type 2 diabetes.Funding Information
- National Institutes of Health (R01, -067690)
- National Heart, Lung, and Blood Institute (R01-HL-94775)
- National Institute of Diabetes and Digestive and Kidney Diseases (K01-DK-106116)
This publication has 31 references indexed in Scilit:
- Relationships between metrics of visit-to-visit variability of blood pressureJournal of Human Hypertension, 2013
- Relationship of visit-to-visit and ambulatory blood pressure variability to vascular function in African AmericansHypertension Research, 2011
- The Relationship Between Ambulatory Arterial Stiffness Index and Blood Pressure Variability in Hypertensive PatientsKorean Circulation Journal, 2011
- Epidemiology and risk profile of heart failureNature Reviews Cardiology, 2010
- Blood Pressure and Cardiovascular Disease Risk in the Veterans Affairs Diabetes TrialDiabetes Care, 2010
- Glucose Control and Vascular Complications in Veterans with Type 2 DiabetesThe New England Journal of Medicine, 2009
- Rationale and Design for the Blood Pressure Intervention of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) TrialThe American Journal of Cardiology, 2007
- Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial: Design and MethodsThe American Journal of Cardiology, 2007
- Diabetes, Hypertension, and Cardiovascular DiseaseHypertension, 2001
- Role of diabetes in congestive heart failure: The Framingham studyThe American Journal of Cardiology, 1974