Standard blood pressure (BP) measurements do not consider the extent and length of exposure to high BP over time. For a study, researchers sought to determine the relationship between type 2 diabetes patients’ cumulative systolic blood pressure (SBP) load and their risk of cardiovascular events.
Type 2 diabetes patients’ posthoc analysis was followed by the ADVANCE-ON (Action in Diabetes and Vascular Disease: Preterax & Diamicron Modified Release Controlled Evaluation – Observational Study). The cumulative SBP load was calculated as the area under the curve for all measured SBP values throughout a 24-month exposure period divided by the area under the curve for SBP values of 130 mm Hg. Using Cox models, HRs were calculated for the relationship between cumulative SBP load and major cardiovascular events and mortality.
In 9,338 patients throughout a median 7.6-year period of follow-up, 1,469 major cardiovascular events, 1,615 fatalities, and 660 cardiovascular deaths were noted. An increase in major cardiovascular events of 14% (HR: 1.14; 95% CI: 1.09-1.20), 13% rise in all-cause mortality (HR: 1.13; 95% CI: 1.13-1.18), and 21% increase in cardiovascular death (HR: 1.21; 95% CI: 1.13-1.29) were all linked to each 1-SD increase in cumulative SBP load. Cumulative SBP load beat mean SBP, time below goal SBP, and visit-to-visit SBP variability for predicting cardiovascular events and mortality in terms of Akaike information criteria and net reclassification indices.
When compared to conventional BP measurements in people with type 2 diabetes, cumulative SBP load may offer a more accurate prediction of major cardiovascular events.
Reference: jacc.org/doi/10.1016/j.jacc.2022.06.039
