Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/83209
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Type: Journal article
Title: Effects of visit-to-visit variability in systolic bloody pressure on macrovascular and microvascular complications in patients with type 2 diabetes mellitus: The ADVANCE Trial
Author: Hata, Jun
Arima, Hisatomi
... et al.
Citation: Circulation, 2013; 128(12):1325-1334
Publisher: Lippincott Williams & Wilkins
Issue Date: 2013
ISSN: 0009-7322
School/Discipline: School of Population Health : Rural Health
Statement of
Responsibility: 
Jun Hata, Hisatomi Arima, Peter M. Rothwell, Mark Woodward, Sophia Zoungas, Craig Anderson, Anushka Patel, Bruce Neal, Paul Glasziou, Pavel Hamet, Giuseppe Mancia, Neil Poulter, Bryan Williams, Stephen MacMahon, John Chalmers on behalf of the ADVANCE Collaborative Group
Abstract: BACKGROUND—Recent evidence suggests that visit-to-visit variability in systolic blood pressure (SBP) and maximum SBP are predictors of cardiovascular disease. However, it remains uncertain whether these parameters predict the risks of macrovascular and microvascular complications in patients with type 2 diabetes mellitus. METHODS AND RESULTS—The Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) was a factorial randomized controlled trial of blood pressure lowering and blood glucose control in patients with type 2 diabetes mellitus. The present analysis included 8811 patients without major macrovascular and microvascular events or death during the first 24 months after randomization. SBP variability (defined as standard deviation) and maximum SBP were determined during the first 24 months after randomization. During a median 2.4 years of follow-up from the 24-month visit, 407 major macrovascular (myocardial infarction, stroke, or cardiovascular death) and 476 microvascular (new or worsening nephropathy or retinopathy) events were observed. The association of major macrovascular and microvascular events with SBP variability was continuous even after adjustment for mean SBP and other confounding factors (both P<0.05 for trend). Hazard ratios (95% confidence intervals) for the highest tenth of SBP variability were 1.54 (0.99–2.39) for macrovascular events and 1.84 (1.19–2.84) for microvascular events in comparison with the lowest tenth. For maximum SBP, hazard ratios (95% confidence intervals) for the highest tenth were 3.64 (1.73–7.66) and 2.18 (1.04–4.58), respectively. CONCLUSION—Visit-to-visit variability in SBP and maximum SBP were independent risk factors for macrovascular and microvascular complications in type 2 diabetes mellitus. CLINICAL TRIAL REGISTRATION—URL: http://www.clinicaltrials.gov. Unique Identifier: NCT00145925.
Keywords: blood pressure; diabetes mellitus, type 2; diabetic nephropathies; myocardial infarction; stroke
Rights: © 2013 American Heart Association, Inc.
RMID: 0020134887
DOI: 10.1161/CIRCULATIONAHA.113.002717
Appears in Collections:Public Health publications

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