[Compiled by Xie Yizhe/Comprehensive Report] An observational study in the Netherlands found that people with type 2 diabetes and large fluctuations in systolic blood pressure had a risk of death almost three times that of people with normal blood sugar and stable blood pressure readings. The study was presented at the annual meeting of the European Association for the Study of Diabetes.
According to the science website "SciTechDaily", a research team from the University Medical Center of Amsterdam in the Netherlands analyzed the blood pressure measurement data of 57,611 participants in the British Biobank. The average age of participants was 55.4 years, and 52% were female. Among the participants, 5,397 had prediabetes, 1,470 had type 2 diabetes, and 50,744 had normoglycemia. The researchers followed participants for a median of 5.1 years from the time they accumulated enough blood pressure measurements to calculate their blood pressure fluctuations. During this period, 1,460 participants died, 571 suffered strokes, and 319 developed dementia.
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After analysis, the research team found that people whose blood pressure changed significantly during different study visits also had a higher risk of death during the follow-up period. People with type 2 diabetes and large fluctuations in systolic blood pressure were 2.8 times more likely to die during the follow-up period than people with normal blood sugar and small fluctuations in systolic blood pressure.
A similar phenomenon was seen in people with prediabetes, who had a 62% increased risk of death compared with people with normal blood sugar and smaller fluctuations in systolic blood pressure. The so-called prediabetes refers to blood sugar that is higher than the normal range, but has not yet reached the diagnostic criteria for diabetes.
In these comparisons, participants in each group had different blood sugar profiles and varying degrees of blood pressure fluctuations, so the increased risk cannot be attributed solely to fluctuations in blood pressure readings. To present the analysis as an absolute risk, the researchers also estimated the chance of death over a 10-year period. Estimates show that the 10-year mortality rate for people with normal blood sugar and small systolic blood pressure fluctuations is about 1%, while for people with type 2 diabetes and large systolic blood pressure fluctuations, the 10-year mortality rate is about 2.9%. These numbers are estimates of longer-term risks, not the mortality rates observed after the study actually followed the study for the full 10 years.
The research team also noted that greater fluctuations in systolic blood pressure, diastolic blood pressure, mean arterial pressure, and pulse pressure were also associated with a higher risk of death from all causes. Mean arterial pressure is the average arterial pressure within one heartbeat cycle, and pulse pressure is the difference between systolic and diastolic blood pressure.
In systolic blood pressure, each standard deviation increase in variability was associated with an 11% increase in the risk of death. In terms of diastolic blood pressure, the corresponding risk of death increased by 8%. When the team further analyzed stroke risk, they found diastolic blood pressure and mean arterial pressure. For every 1 standard deviation increase in the volatility of these two indicators, the risk of stroke increased by 12% and 10% respectively. Standard deviation reflects the dispersion of blood pressure fluctuations among participants, so the study results cannot be directly converted into millimeters of mercury (mmHg) that blood pressure rises or falls.
The research team stated that this is an observational study, so it cannot prove that blood pressure fluctuations directly cause death or stroke, but the degree of blood pressure fluctuations may help medical staff identify some high-risk patients who might otherwise be ignored. In the future, when patients return to the clinic and have a blood pressure cuff wrapped around their arm to measure their blood pressure, medical staff may be able to pay more careful attention to changes between different measurement time points.
