The extent to which baseline blood pressure (BP) level modifies associations between BP variability and cardiovascular disease (CVD) is underexplored. Thus, we used data from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, which consists of individuals with type 2 diabetes (T2D) undergoing glucose and other risk factor management, to assess the relationship of visit-to-visit BP variability (estimated by coefficient of variation - CV) with the primary composite cardiovascular outcome (MACE), major coronary heart disease (CHD), and total stroke. Using time-dependent Cox proportional hazards models (adjusted for randomization arm and other relevant risk factors, including mean systolic or diastolic BP - SBP and DBP), CV-SBP and CV-DBP were associated with MACE and CHD, but not stroke in the whole group (Figure). When stratifying the cohort by baseline BP level, an overall U-shaped pattern of risk with SBP and DBP variability was observed for both MACE and CHD (Figure). Our findings suggest that BP variability is an independent risk factor for CVD, particularly for those with either elevated or low BP. It is possible that BP variability induces CVD via different mechanisms depending on the mean pressure level. Our data further support the importance of individualized BP management in those with T2D.
D. S. Nuyujukian: None. J. Zhou: None. J. Koska: None. P. Reaven: Research Support; Self; AstraZeneca, Dexcom, Inc.
National Institutes of Health (R01067690, R01094775)