TY - JOUR
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
N1 - Publisher Copyright:
© 2016 Elsevier Ireland Ltd.
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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U2 - 10.1016/j.diabres.2016.01.010
DO - 10.1016/j.diabres.2016.01.010
M3 - Article
C2 - 26809904
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 -