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Prognostic impact of clinic and ambulatory blood pressure components in high-risk type 2 diabetic patients: the Rio de Janeiro Type 2 Diabetes Cohort Study

Salles, Gil F.a; Leite, Nathalie C.a; Pereira, Basílio B.b; Nascimento, Emilia M.b,c; Cardoso, Claudia R.L.a

doi: 10.1097/HJH.0b013e328364103f
ORIGINAL PAPERS: BP measurement

Background: The prognostic importance of tight clinic blood pressure (BP) control is controversial in diabetic patients. The objective was to investigate the prognostic impact of clinic and ambulatory BPs for cardiovascular morbidity and mortality in type 2 diabetes.

Methods: In a prospective cohort study, 565 type 2 diabetic patients had clinical, laboratory and ambulatory BP monitoring (ABPM) data obtained at baseline and during follow-up. The primary endpoints were a composite of fatal and nonfatal cardiovascular events and all-cause mortality. Multivariable Cox survival and splines regression analyses assessed associations between each BP component [SBP, DBP and pulse pressure (PP)] and the endpoints.

Results: After a median follow-up of 5.75 years, 88 total cardiovascular events and 70 all-cause deaths occurred. After adjustments for cardiovascular risk factors, clinic SBP and DBPs were predictive of the composite endpoint but not of all-cause mortality, whereas all ambulatory BP components were predictors of both endpoints. Ambulatory systolic and PPs were the strongest predictors and achieved ambulatory BPs during follow-up improved risk prediction in relation to baseline values. When categorized at clinically relevant cut-off values, risk began only at clinic BPs at least 140/90 mmHg, whereas for ambulatory BPs it began at lower values (≥120/75 mmHg for the 24-h period).

Conclusion: ABPM provides more valuable information regarding cardiovascular risk stratification than office BPs and should be performed, if possible, in every high-risk type 2 diabetic patient. Achieved 24-h ambulatory BPs less than 120/75 mmHg are associated with significant cardiovascular protection and, if confirmed by other studies, may be considered as BP treatment targets.

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aDepartment of Internal Medicine

bDepartment of Preventive Medicine, University Hospital Clementino Fraga Filho, School of Medicine

cPostgraduate School of Engineering – COPPE, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil

Correspondence to Gil Fernando Salles, Rua Croton, 72, Jacarepagua, Rio de Janeiro, RJ CEP: 22750-240, Brazil. Tel: +55 21 2447 3577; fax: +55 21 2562 2514; e-mail: gilsalles@hucff.ufrj.br

Abbreviations: ABPM, ambulatory blood pressure monitoring; AIC, Akaike information criterion; AMI, acute myocardial infarction; BIC, Bayesian information criterion; BP, blood pressure; PP, pulse pressure

Received 6 March, 2013

Revised 7 May, 2013

Accepted 10 June, 2013

Part of this study was presented at the 22nd European Meeting on Hypertension and Cardiovascular Protection in London, April 2012.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://www.jhypertension.com).

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins