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Factors affecting variability in home blood pressure in patients with type 2 diabetes: post hoc analysis of a cross-sectional multicenter study

Abstract

Recent studies have shown that variability in home blood pressure has an important role in the progression of organ damage. The objective of this study was to investigate the factors that affect variability in home blood pressure in patients with type 2 diabetes. We assessed the relationship between home blood pressure variability, defined as coefficient of variation of mean of triplicate morning and evening blood pressure for 14 consecutive days, and various factors using univariate and multivariate linear regression analyses in 1114 patients with type 2 diabetes. Age (β=0.149, P<0.001), female sex (β=0.125, P=0.010), duration of diabetes mellitus (β=0.103, P=0.005), heart rate (β=0.136, P<0.001), current smoker (β=0.118, P=0.005), white-coat hypertension (β=0.136, P=0.002) and treatment with calcium channel blockers (β=−0.094, P=0.024) were independently associated with coefficient of variation of morning systolic blood pressure. Our findings implicate that factors that might be intervened such as heart rate, smoking status, use of antihypertensive medication in addition to age, sex and duration of diabetes mellitus are associated with variability in home blood pressure in patients with type 2 diabetes.

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References

  1. Niiranen T, Jula A, Kantola I, Moilanen L, Kähönen M, Kesäniemi YA et al. Home-measured blood pressure is more strongly associated with atherosclerosis than clinic blood pressure: the Finn-Home study. J Hypertens 2007; 25: 1225–1231.

    Article  CAS  Google Scholar 

  2. Niiranen TJ, Jula AM, Kantola IM, Karanko H, Reunanen A . Home-measured blood pressure is more strongly associated with electrocardiographic left ventricular hypertrophy than is clinic blood pressure: the Finn-Home study. J Hum Hypertens 2007; 21: 788–794.

    Article  CAS  Google Scholar 

  3. Ohkubo T, Imai Y, Tsuji I, Nagai K, Kato J, Kikuchi N et al. Home blood pressure measurement has a stronger predictive power for mortality than does screening blood pressure measurement: a population-based observation in Ohasama, Japan. J Hypertens 1998; 16: 971–975.

    Article  CAS  Google Scholar 

  4. Kikuya M, Hozawa A, Ohokubo T, Tsuji I, Michimata M, Matsubara M et al. Prognostic significance of blood pressure and heart rate variabilities: the Ohasama study. Hypertension 2000; 36: 901–906.

    Article  CAS  Google Scholar 

  5. Kikuya M, Ohkubo T, Metoki H, Asayama K, Hara A, Obara T et al. Day-by-day variability of blood pressure and heart rate at home as a novel predictor of prognosis: the Ohasama study. Hypertension 2008; 52: 1045–1050.

    Article  CAS  Google Scholar 

  6. Johansson JK, Niiranen TJ, Puukka PJ, Jula AM . Prognostic value of the variability in home-measured blood pressure and heart rate: the Finn-Home study. Hypertension 2012; 59: 212–218.

    Article  CAS  Google Scholar 

  7. Asayama K, Kikuya M, Schutte R, Thijs L, Hosaka M, Satoh M et al. Home blood pressure variability as cardiovascular risk factor in the population of Ohasama. Hypertension 2013; 61: 61–69.

    Article  CAS  Google Scholar 

  8. Okada T, Matsumoto H, Nagaoka Y, Nakao T . Association of home blood pressure variability with progression of chronic kidney disease. Blood Press Monit 2012; 17: 1–7.

    Article  Google Scholar 

  9. Ushigome E, Fukui M, Hamaguchi M, Senmaru T, Sakabe K, Tanaka M et al. The coefficient variation of home blood pressure is a novel factor associated with macroalbuminuria in type 2 diabetes mellitus. Hypertens Res 2011; 34: 1271–1275.

    Article  CAS  Google Scholar 

  10. Johansson JK, Niiranen TJ, Puukka PJ, Jula AM . Factors affecting the variability of home-measured blood pressure and heart rate: the Finn-Home study. J Hypertens 2010; 28: 1836–1845.

    Article  CAS  Google Scholar 

  11. Kato T, Kikuya M, Ohkubo T, Satoh M, Hara A, Obara T et al. Factors associated with day-by-day variability of self-measured blood pressure at home: the Ohasama study. Am J Hypertens 2010; 23: 980–986.

    Article  Google Scholar 

  12. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 2003; 26: S5–S20.

  13. Ogihara T, Kikuchi K, Matsuoka H, Fujita T, Higaki J, Horiuchi M et al Japanese Society of Hypertension Committee. The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2009). Hypertens Res 2009; 32: 3–107.

    CAS  PubMed  Google Scholar 

  14. Yasuda H, Sanada M, Kitada K, Terashima T, Kim H, Sakaue Y et al. Rationale and usefulness of newly devised abbreviated diagnostic criteria and staging for diabetic polyneuropathy. Diabetes Res Clin Pract 2007; 77: S178–S183.

    Article  CAS  Google Scholar 

  15. Coleman A, Freeman P, Steel S, Shennan A . Validation of the Omron 705IT (HEM-759-E) oscillometric blood pressure monitoring device according to the British Hypertension Society protocol. Blood Press Monit 2006; 11: 27–32.

    Article  CAS  Google Scholar 

  16. Imai Y, Otsuka K, Kawano Y, Shimada K, Hayashi H, Tochikubo O et al Japanese Society of Hypertension. Japanese society of hypertension (JSH) guidelines for self-monitoring of blood pressure at home. Hypertens Res 2003; 26: 771–782.

    Article  Google Scholar 

  17. Shin JH, Shin J, Kim BK, Lim Y-H, Park H-C, Choi SI et al. Within-visit blood pressure variability: relevant factors in the general population. J Hum hypertens 2013; 27: 328–334.

    Article  CAS  Google Scholar 

  18. McGarry K, Laher M, Fitzgerald D, Horgan J, O’Brien E, O’Malley K . Baroreflex function in elderly hypertensives. Hypertension 1983; 5: 763–766.

    Article  CAS  Google Scholar 

  19. Gribbin B, Pickering TG, Sleight P, Peto R . Effect of age and high blood pressure on baroreflex sensitivity in man. Circ Res 1971; 29: 424–431.

    Article  CAS  Google Scholar 

  20. O’Rourke MF, Hashimoto J . Mechanical factors in arterial aging: a clinical perspective. J Am Coll Cardiol 2007; 50: 1–13.

    Article  Google Scholar 

  21. Nilsson PM, Lurbe E, Laurent S . The early life origins of vascular ageing and cardiovascular risk: the EVA syndrome. J Hypertens 2008; 26: 1049–1057.

    Article  CAS  Google Scholar 

  22. Mancia G, Grassi G . Mechanisms and clinical implications of blood pressure variability. J Cardiovasc Pharmacol 2000; 35: S15–S19.

    Article  CAS  Google Scholar 

  23. Conway J, Boon N, Davies C, Jones JV, Sleight P . Neural and humoral mechanisms involved in blood pressure variability. J Hypertens 1984; 2: 203–208.

    Article  CAS  Google Scholar 

  24. Franklin SS . Do diabetes and hypertension interact to accelerate vascular ageing? J Hypertens 2002; 20: 1693–1696.

    Article  CAS  Google Scholar 

  25. Smith A, Karalliedde J, De Angelis L, Goldsmith D, Viberti G . Aortic pulse wave velocity and albuminuria in patients with type 2 diabetes. J Am Soc Nephrol 2005; 16: 1069–1075.

    Article  Google Scholar 

  26. Ishikura K, Obara T, Kato T, Kikuya M, Shibamiya T, Shinki T et al. Associations between day-by-day variability in blood pressure measured at home and antihypertensive drugs: the J-HOME-Morning study. Clin Exp Hypertens 2012; 34: 297–304.

    Article  CAS  Google Scholar 

  27. Su H, Wang J, Zhu Y, Wang G, Cheng X . Discrepancy among three blood pressure readings within one measurement and relevant influencing factors. Blood Press Monit 2010; 15: 152–157.

    Article  Google Scholar 

  28. Robertson D, Johnson GA, Robertson RM, Nies AS, Shand DG, Oates JA . Comparative assessment of stimuli that release neuronal and adrenomedullary catecholamines in man. Circulation 1979; 59: 637–643.

    Article  CAS  Google Scholar 

  29. Hashimoto T, Kikuya M, Ohkubo T, Satoh M, Metoki H, Inoue R et al. Home blood pressure level, blood pressure variability, smoking, and stroke risk in Japanese men: the Ohasama study. Am J Hypertens 2012; 25: 883–891.

    Article  Google Scholar 

  30. Kawabe H, Kanda T, Hirose H, Saito I . Variability of home blood pressure measurements between first and second measurements on one occasion, and factors related to variability. Clin Exp Hypertens 2012; 34: 237–242.

    Article  Google Scholar 

  31. Abe H, Kawano Y, Kojima S, Ashida T, Kuramochi M, Matsuoka H et al. Biphasic effects of repeated alcohol intake on 24-hour blood pressure in hypertensive patients. Circulation 1994; 89: 2626–2633.

    Article  CAS  Google Scholar 

  32. Minami J, Todoroki M, Ishimitsu T, Yamamoto H, Abe S, Fukunaga T et al. Effects of alcohol intake on ambulatory blood pressure, heart rate, and heart rate variability in Japanese men with different ALDH2 genotypes. J Hum Hypertens 2002; 16: 345–351.

    Article  CAS  Google Scholar 

  33. Kawano Y, Abe H, Kojima S, Yoshimi H, Sanai T, Kimura G et al. Different effects of alcohol and salt on 24-hour blood pressure and heart rate in hypertensive patients. Hypertens Res 1996; 19: 255–261.

    Article  CAS  Google Scholar 

  34. Ohira T, Tanigawa T, Tabata M, Imano H, Kitamura A, Kiyama M et al. Effects of habitual alcohol intake on ambulatory blood pressure, heart rate, and its variability among Japanese men. Hypertension 2009; 53: 13–19.

    Article  CAS  Google Scholar 

  35. Pickering TG, Shimbo D, Haas D . Ambulatory blood-pressure monitoring. N Engl J Med 2006; 354: 2368–2374.

    Article  CAS  Google Scholar 

  36. Webb AJS, Fischer U, Mehta Z, Rothwell PM . Effects of antihypertensive-drug class on interindividual variation in blood pressure and risk of stroke: a systematic review and meta-analysis. Lancet 2010; 375: 906–915.

    Article  CAS  Google Scholar 

  37. Van der Hoeven NV, Van den Born B-JH, Cammenga M, Van Montfrans GA . Poor adherence to home blood pressure measurement schedule. J Hypertens 2009; 27: 275–279.

    Article  CAS  Google Scholar 

  38. Johansson JK, Kronholm E, Jula AM . Variability in home-measured blood pressure and heart rate: associations with self-reported insomnia and sleep duration. J Hypertens 2011; 29: 1897–1905.

    Article  CAS  Google Scholar 

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Acknowledgements

We thank Shinobu Matsumoto, Atsushi Omoto, Wataru Fukuda, Masayoshi Ohnishi and Yoshihiro Kitagawa for collecting data, Naoko Higo, Machiko Hasegawa and Terumi Kaneko for teaching patients how to measure their blood pressure and Sayoko Horibe, Hiroko Kawamura and Haruka Ooseto for their secretarial assistance.

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Correspondence to M Fukui.

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Ushigome, E., Fukui, M., Hamaguchi, M. et al. Factors affecting variability in home blood pressure in patients with type 2 diabetes: post hoc analysis of a cross-sectional multicenter study. J Hum Hypertens 28, 594–599 (2014). https://doi.org/10.1038/jhh.2014.2

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