Long-Term BP Variability Linked to Cardiovascular Mortality in T2D

The link between long-term blood pressure variability and cardiovascular outcomes were studied in individuals with type 2 diabetes.

In patients with type 2 diabetes (T2D), greater variability in systolic blood pressure (SBP) and diastolic blood pressure (DBP) was associated with an increased cardiovascular mortality risk, according to the results of a study published in the American Journal of Hypertension.

Data from the Look AHEAD (Action for Health in Diabetes) study, a multicenter, randomized clinical trial, were analyzed. Patients (N=4152) with T2D were recruited from 2001 to 2004 at 16 centers in the United States and randomized to participate in an intensive lifestyle intervention or to receive diabetes support and education. Longitudinal BPs assessed at 4 yearly visits were correlated with cardiovascular disease (CVD) events.

At baseline, the mean age of the study patients was 58.9 years (standard deviation [SD], 6.8); 58.8% were women, 67.7% were White, BMI was 35.9 kg/m2 (SD, 5.9), 13.3% had a history of CVD, and T2D had been diagnosed at a median of 5.0 years (interquartile range [IQR], 2.0-10.0) previously.

During a median follow-up of 6.6 years, 236 all-cause deaths, 62 CVD-related deaths, 220 myocardial infarctions, 105 strokes, and 350 composite CVD events occurred.

Stratified by SD of SBP tertiles, patients in the highest tertile were at increased risk for CVD mortality (adjusted hazard ratio [aHR], 1.98; 95% CI 1.01-3.92; P =.030) and stroke (aHR, 1.64; 95% CI 0.99-2.72; P =.043) but not for all-cause mortality (aHR, 1.25; 95% CI 0.90-1.72; P =.144), CVD (aHR, 1.26; 95% CI 0.96-1.64; P =.066), or myocardial infarctions (aHR, 1.05; 95% CI 0.75-1.46; P =.722) compared with individuals in the lowest tertile.

Similarly, individuals in the highest tertile for SD of DBP were at increased risk for all-cause mortality (aHR, 1.43; 95% CI 1.03-1.98; P =.029) and CVD mortality (aHR, 1.84; 95% CI 0.98-3.48; P =.046) but not for CVD (aHR, 1.19; 95% CI 0.91-1.56; P =.196), myocardial infarctions (aHR, 1.14; 95% CI 0.82-1.58; P =.432), or stroke (aHR, 0.97; 95% CI 0.58-1.60; P =.870) compared with the lowest tertile.

This study was limited by not including data on adherence to hypertensive medications, which could have altered BP variability. The study data indicated that long-term variability of SBP and DBP increased the risk of CVD mortality in adults with T2D.

“Our findings highlight the relevance of visit-to-visit variability of BP in the prediction of CVD outcomes and deaths in people [with] type 2 diabetes and underscore the necessity of stable and consistent BP control in this population”, the study authors concluded.


Kaze AD, Santhanam P, Erqou S, et al. Long-term variability of blood pressure, cardiovascular outcomes, and mortality: the Look AHEAD study. Am J Hypertens. Published online April 2, 2021. doi:10.1093/ajh/hpaa210