Systolic blood pressure variability and lower extremity amputation in a non-elderly population with diabetes

Elly Budiman-Mak; Noam Epstein; Meghan Brennan; Rodney Stuck; Marylou Guihan; Zhiping Huo; Nicholas Emanuele; Min Woong Sohn

doi:10.1016/j.diabres.2016.01.010

Systolic blood pressure variability and lower extremity amputation in a non-elderly population with diabetes

Elly Budiman-Mak, Noam Epstein, Meghan Brennan, Rodney Stuck, Marylou Guihan, Zhiping Huo, Nicholas Emanuele, Min Woong Sohn

Research output: Contribution to journal › Article › peer-review

14 Scopus citations

Abstract

Objective: Systolic blood pressure (SBP) variability is emerging as a new risk factor for cardiovascular diseases, diabetic nephropathy, and other atherosclerotic conditions. Our objective is to examine whether it has any prognostic value for lower-extremity amputations. Research design and methods: This is a nested case-control study of a cohort of patients with diabetes aged < 60 years and treated in the US Department of Veterans Healthcare system in 2003. They were followed over five years for any above-ankle (major) amputations. For each case with a major amputation (event), we randomly selected up to five matched controls based on age, sex, race/ethnicity, and calendar time. SBP variability was computed using three or more blood pressure measures taken during the one-year period before the event. Patients were classified into quartiles according to their SBP variability. Results: The study sample included 1038 cases and 2932 controls. Compared to Quartile 1 (lowest variability), Quartile 2 had 1.4 times (OR = 1.44, 95% CI = 1.00-2.07) and Quartiles 3 and 4 (highest) had 2.5 times (OR for Quartile 3 = 2.62, 95% CI = 1.85-3.72; OR for Quartile 4 = 2.50, 95% CI = 1.74-3.59) higher risk of major amputation (P for trend < 0.001). This gradient relationship held in both normotensive and hypertensive groups as well as for individuals without prior peripheral vascular disease. Conclusions: This is the first study to show a significant graded relationship between SBP variability and risk of major amputation among non-elderly persons with diabetes.

Original language	English
Pages (from-to)	75-82
Number of pages	8
Journal	Diabetes Research and Clinical Practice
Volume	114
DOIs	https://doi.org/10.1016/j.diabres.2016.01.010
State	Published - Apr 1 2016

Bibliographical note

Publisher Copyright:
© 2016 Elsevier Ireland Ltd.

Funding

The authors gratefully acknowledge the financial support from the US Department of Veterans Affairs, Health Services Research and Development Services ( LIP 42-151 ), the Agency for Healthcare Research and Quality ( 1R01HS018542-01A2 ), and the National Institutes of Health ( UL1TR000427 and KL2TR000428 ). The paper presents the findings and conclusions of the authors; it does not necessarily represent the Department of Veterans Affairs, Health Services Research and Development Service, or the Agency for Healthcare Research and Quality. We thank Mary Reidy of Hines VA Hospital for help in the preparation of this manuscript. The corresponding author had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Funders	Funder number
National Institutes of Health (NIH)	KL2TR000428
Agency for Healthcare Research and Quality	1R01HS018542-01A2
U.S. Department of Veterans Affairs
National Center for Advancing Translational Sciences (NCATS)	UL1TR000427
Health Services Research and Development Center for Mental Health Outcomes Research	LIP 42-151

Keywords

Diabetic complication
Lower-extremity amputation
Systolic blood pressure

ASJC Scopus subject areas

Internal Medicine
Endocrinology, Diabetes and Metabolism
Endocrinology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.diabres.2016.01.010

Cite this

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title = "Systolic blood pressure variability and lower extremity amputation in a non-elderly population with diabetes",

abstract = "Objective: Systolic blood pressure (SBP) variability is emerging as a new risk factor for cardiovascular diseases, diabetic nephropathy, and other atherosclerotic conditions. Our objective is to examine whether it has any prognostic value for lower-extremity amputations. Research design and methods: This is a nested case-control study of a cohort of patients with diabetes aged < 60 years and treated in the US Department of Veterans Healthcare system in 2003. They were followed over five years for any above-ankle (major) amputations. For each case with a major amputation (event), we randomly selected up to five matched controls based on age, sex, race/ethnicity, and calendar time. SBP variability was computed using three or more blood pressure measures taken during the one-year period before the event. Patients were classified into quartiles according to their SBP variability. Results: The study sample included 1038 cases and 2932 controls. Compared to Quartile 1 (lowest variability), Quartile 2 had 1.4 times (OR = 1.44, 95% CI = 1.00-2.07) and Quartiles 3 and 4 (highest) had 2.5 times (OR for Quartile 3 = 2.62, 95% CI = 1.85-3.72; OR for Quartile 4 = 2.50, 95% CI = 1.74-3.59) higher risk of major amputation (P for trend < 0.001). This gradient relationship held in both normotensive and hypertensive groups as well as for individuals without prior peripheral vascular disease. Conclusions: This is the first study to show a significant graded relationship between SBP variability and risk of major amputation among non-elderly persons with diabetes.",

keywords = "Diabetic complication, Lower-extremity amputation, Systolic blood pressure",

author = "Elly Budiman-Mak and Noam Epstein and Meghan Brennan and Rodney Stuck and Marylou Guihan and Zhiping Huo and Nicholas Emanuele and Sohn, {Min Woong}",

note = "Publisher Copyright: {\textcopyright} 2016 Elsevier Ireland Ltd.",

year = "2016",

month = apr,

day = "1",

doi = "10.1016/j.diabres.2016.01.010",

language = "English",

volume = "114",

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T1 - Systolic blood pressure variability and lower extremity amputation in a non-elderly population with diabetes

AU - Budiman-Mak, Elly

AU - Epstein, Noam

AU - Brennan, Meghan

AU - Stuck, Rodney

AU - Guihan, Marylou

AU - Huo, Zhiping

AU - Emanuele, Nicholas

AU - Sohn, Min Woong

PY - 2016/4/1

Y1 - 2016/4/1

N2 - Objective: Systolic blood pressure (SBP) variability is emerging as a new risk factor for cardiovascular diseases, diabetic nephropathy, and other atherosclerotic conditions. Our objective is to examine whether it has any prognostic value for lower-extremity amputations. Research design and methods: This is a nested case-control study of a cohort of patients with diabetes aged < 60 years and treated in the US Department of Veterans Healthcare system in 2003. They were followed over five years for any above-ankle (major) amputations. For each case with a major amputation (event), we randomly selected up to five matched controls based on age, sex, race/ethnicity, and calendar time. SBP variability was computed using three or more blood pressure measures taken during the one-year period before the event. Patients were classified into quartiles according to their SBP variability. Results: The study sample included 1038 cases and 2932 controls. Compared to Quartile 1 (lowest variability), Quartile 2 had 1.4 times (OR = 1.44, 95% CI = 1.00-2.07) and Quartiles 3 and 4 (highest) had 2.5 times (OR for Quartile 3 = 2.62, 95% CI = 1.85-3.72; OR for Quartile 4 = 2.50, 95% CI = 1.74-3.59) higher risk of major amputation (P for trend < 0.001). This gradient relationship held in both normotensive and hypertensive groups as well as for individuals without prior peripheral vascular disease. Conclusions: This is the first study to show a significant graded relationship between SBP variability and risk of major amputation among non-elderly persons with diabetes.

AB - Objective: Systolic blood pressure (SBP) variability is emerging as a new risk factor for cardiovascular diseases, diabetic nephropathy, and other atherosclerotic conditions. Our objective is to examine whether it has any prognostic value for lower-extremity amputations. Research design and methods: This is a nested case-control study of a cohort of patients with diabetes aged < 60 years and treated in the US Department of Veterans Healthcare system in 2003. They were followed over five years for any above-ankle (major) amputations. For each case with a major amputation (event), we randomly selected up to five matched controls based on age, sex, race/ethnicity, and calendar time. SBP variability was computed using three or more blood pressure measures taken during the one-year period before the event. Patients were classified into quartiles according to their SBP variability. Results: The study sample included 1038 cases and 2932 controls. Compared to Quartile 1 (lowest variability), Quartile 2 had 1.4 times (OR = 1.44, 95% CI = 1.00-2.07) and Quartiles 3 and 4 (highest) had 2.5 times (OR for Quartile 3 = 2.62, 95% CI = 1.85-3.72; OR for Quartile 4 = 2.50, 95% CI = 1.74-3.59) higher risk of major amputation (P for trend < 0.001). This gradient relationship held in both normotensive and hypertensive groups as well as for individuals without prior peripheral vascular disease. Conclusions: This is the first study to show a significant graded relationship between SBP variability and risk of major amputation among non-elderly persons with diabetes.

KW - Diabetic complication

KW - Lower-extremity amputation

KW - Systolic blood pressure

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AN - SCOPUS:84955253464

SN - 0168-8227

VL - 114

SP - 75

EP - 82

JO - Diabetes Research and Clinical Practice

JF - Diabetes Research and Clinical Practice

ER -

Systolic blood pressure variability and lower extremity amputation in a non-elderly population with diabetes

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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