We examined the relationship between blood pressure variability and risk of heart failure (HF) in two cohorts of type 2 diabetes (T2D) participating in trials of glucose and/or other risk factor management. 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. In ACCORD (Table), 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: 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 (e.g., for CV-SBP: those with baseline SBP ≥ 140, < 140, < 130 and < 120 mmHg, respectively had the following HRs; 1.03, 1.21, 1.50, and 1.69). Blood pressure variability is independently associated with HF risk and this relationship is most robust at low blood pressure in individuals with T2D. These results may have implications for optimizing blood pressure treatment strategies in those with T2D.
D.S. Nuyujukian: None. J. Koska: None. P. Reaven: Consultant; Self; Boston Heart Diagnostics, Intercept Pharmaceuticals, Inc. Research Support; Self; Bristol-Myers Squibb, Lysulin. J. Zhou: None.
National Institutes of Health (R01067690, R01094775)