Minimum number of readings necessary for determining long-term visit-to-visit blood pressure variability to predict cardiovascular outcomes in people with diabetes

초록

Background: People with diabetes often have increased blood pressure (BP) variability because of autonomic dysfunction and arterial stiffness, making it a critical factor in predicting clinical outcomes. We investigated the reproducibility of long-term visit-to-visit BP variability (VVV) and the minimum number of BP readings to reliably determine VVV in people with diabetes. Methods: This multicenter retrospective study used data from electronic health records of the Korea University Medical Center database. Altogether, 10475 people with diabetes who had more than nine BP readings during a maximum period of 2years were identified. This study focused on the coefficient of variation of these readings and their correlation with major adverse cardiovascular events (MACE) over a 3-year follow-up period. Results: The mean age of the participants was 65.2years. Of these, 53.2% were men, and 87.4% had hypertension. The mean coefficient of variation of multiple SBP readings that best predicted the 3-year MACE were 8.4, 9.5, 9.0, 9.0, and 9.7 for three, five, seven, nine, and all readings, respectively. Patients with high VVV (coefficient of variation of five SBP readings >9) exhibited a higher incidence of 3-year MACE (10.1%) than those with low VVV (5.4%, P<0.001). In the multivariable analysis, high VVV of both SBP and DBP were independently associated with 3-year MACE. Conclusion: Long-term VVV in the BP is a reproducible and reliable predictor of cardiovascular outcomes in people with diabetes. A minimum of five BP measurements are recommended for effective intraindividual VVV estimation and cardiovascular risk assessment. © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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