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 - Funding Information:
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.
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
VL - 114
SP - 75
EP - 82
JO - Diabetes Research and Clinical Practice
JF - Diabetes Research and Clinical Practice
SN - 0168-8227
ER -
