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Blood pressure variability in individuals with and without (pre)diabetes: The Maastricht Study

Zhou, Tan, Laia,b; Kroon, Abraham, A.a,b; Reesink, Koen, D.b,c; Schram, Miranda, T.a,b,d; Koster, Annemariee,f; Schaper, Nicolaas, C.a,b,f; Dagnelie, Pieter, C.b,f,g; van der Kallen, Carla, J.H.a,b; Sep, Simone, J.S.a,b; Stehouwer, Coen, D.A.a,b; Henry, Ronald, M.A.a,b,d

doi: 10.1097/HJH.0000000000001543

Objective: The mechanisms associating (pre)diabetes and cardiovascular disease (CVD) are incompletely understood. We hypothesize that greater blood pressure variability (BPV) may underlie this association, due to its association with (incident) CVD. Therefore, we investigated the association between (pre)diabetes and very short-term to mid-term BPV, that is within-visit, 24-h and 7-day BPV.

Methods: Cross-sectional data from The Maastricht Study [normal glucose metabolism (NGM), n = 1924; prediabetes, n = 511; type 2 diabetes mellitus (T2DM), n = 975; 51% men, aged 60 ± 8 years]. We determined SD for within-visit BPV (n = 3244), average real variability for 24-h BPV (n = 2699) day (0900–2100 h) and night (0100–0600 h) separately, and SD for 7-day BPV (n = 2259). Differences in BPV as compared with NGM were assessed by multiple linear regressions with adjustment for potential confounders.

Results: In T2DM, the average systolic/diastolic values of within-visit, 24-h and 7-day BPV were 4.8/2.6, 10.5/7.3 and 10.4/6.5 mmHg, respectively, and in prediabetes 4.9/2.6, 10.3/7.0 and 9.4/5.9 mmHg, respectively. T2DM was associated with greater nocturnal systolic BPV [0.42 mmHg (95% confidence interval: 0.05–0.80)], and greater 7-day systolic [0.76 mmHg (0.32–1.19)] and diastolic BPV [0.65 mmHg (0.29–1.01)], whereas prediabetes was associated with greater within-visit systolic BPV only [0.35 mmHg (0.06–0.65)], as compared with NGM.

Conclusion: Both T2DM and prediabetes are associated with slightly greater very short-term to mid-term BPV, which may, according to previous literature, explain a small part of the increased CVD risk seen in (pre)diabetes. Nevertheless, these findings do not detract from the fact that very short-term to mid-term BPV is substantial and important in individuals with and without (pre)diabetes.

aDepartment of Internal Medicine, Maastricht University Medical Centre+

bCardiovascular Research Institute Maastricht (CARIM)

cDepartment of Biomedical Engineering, Maastricht University

dHeart and Vascular Centre, Maastricht University Medical Centre+

eDepartment of Social Medicine

fCare and Public Health Research Institute (CAPHRI)

gDepartment of Epidemiology, Maastricht University, Maastricht, The Netherlands

Correspondence to Ronald M.A. Henry, Department of Internal Medicine, Maastricht University Medical Centre+, P. Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, The Netherlands. Tel: +31 43 387 15 62; fax: +31 43 387 50 06; e-mail:

Abbreviations: BPV, blood pressure variability; CKD-EPI, Chronic Kidney Disease Epidemiology Collaboration; eGFR, estimated glomerular filtration rate; HDL-C, HDL cholesterol; LDL-C, LDL cholesterol; NGM, normal glucose metabolism; T2DM, type 2 diabetes mellitus

Received 23 May, 2017

Revised 28 July, 2017

Accepted 3 August, 2017

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