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*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


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 languageEnglish (US)
Pages (from-to)75-82
Number of pages8
JournalDiabetes Research and Clinical Practice
StatePublished - Apr 1 2016


  • Diabetic complication
  • Lower-extremity amputation
  • Systolic blood pressure

ASJC Scopus subject areas

  • Endocrinology
  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism


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