Blood Pressure Variability and Risk of Heart Failure in ACCORD and the VADT
Blood Pressure Variability and Risk of Heart Failure in ACCORD and the VADT
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DOI：
10.2337/dc19-2540
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发表时间：
2020-07-01
期刊：
影响因子：
16.2
通讯作者：
Zhou, Jin J.
中科院分区：
文献类型：
--
作者：
Nuyujukian, Daniel S.;Koska, Juraj;Zhou, Jin J.
目的 尽管血压变异性越来越被认为是心血管疾病的危险因素，但其与心力衰竭 (HF) 的关系尚不清楚。我们在参与血糖和/或其他危险因素管理试验的两组 2 型糖尿病患者中检查了血压变异性与心力衰竭风险之间的关系。研究设计和方法 数据来自控制糖尿病心血管风险行动 (ACCORD) 试验和退伍军人事务部糖尿病试验 (VADT)。在两项试验期间，计算了收缩压 (SBP) 和舒张压 (DBP) 的变异系数 (CV) 和平均真实变异性 (ARV)，以及最大和累积平均 SBP 和 DBP。结果 在 ACCORD 中，SBP 和 DBP 的 CV 和 ARV 与心力衰竭风险增加相关，即使在调整其他危险因素和平均血压后也是如此（例如 CV-SBP：风险比 [HR] 1.15，P= 0.01；CV-DBP：HR 1.18，P= 0.003）。在 VADT 中，DBP 变异性与心力衰竭风险增加相关（ARV-DBP：HR 1.16，P= 0.001；CV-DBP：HR 1.09，P= 0.04）。此外，在 ACCORD 中，基线血压逐渐降低的患者，随着 CV-SBP、ARV-SBP 和 CV-DBP 升高，心力衰竭风险逐步增加。血压变异性的影响与血压的下降而不是升高有关。结论 2 型糖尿病患者的血压变异性与心力衰竭风险相关，这可能是舒张期缺血期间的结果。这些结果可能对优化 2 型糖尿病患者的血压治疗策略具有影响。
OBJECTIVE Although blood pressure variability is increasingly appreciated as a risk factor for cardiovascular disease, its relationship with heart failure (HF) is less clear. We examined the relationship between blood pressure variability and risk of HF in two cohorts of type 2 diabetes participating in trials of glucose and/or other risk factor management. RESEARCH DESIGN AND METHODS 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. RESULTS In ACCORD, 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: hazard ratio [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. Effects of blood pressure variability were related to dips, not elevations, in blood pressure. CONCLUSIONS Blood pressure variability is associated with HF risk in individuals with type 2 diabetes, possibly a consequence of periods of ischemia during diastole. These results may have implications for optimizing blood pressure treatment strategies in those with type 2 diabetes.