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Association between within-visit systolic blood pressure variability and development of pre-diabetes and diabetes among overweight/obese individuals

Journal of Human Hypertension volume 32, pages 26–33 (2018)Cite this article

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Abstract

Short-term blood pressure variability is associated with pre-diabetes/diabetes cross-sectionally, but there are no longitudinal studies evaluating this association. The objective of this study is to evaluate the association between within-visit systolic and diastolic blood pressure variability and development of pre-diabetes/diabetes longitudinally. The study was conducted among eligible participants from the San Juan Overweight Adults Longitudinal Study (SOALS), who completed the 3-year follow-up exam. Participants were Hispanics, 40–65 years of age, and free of diabetes at baseline. Within-visit systolic and diastolic blood pressure variability was defined as the maximum difference between three measures, taken a few minutes apart, of systolic and diastolic blood pressure, respectively. Diabetes progression was defined as development of pre-diabetes/diabetes over the follow-up period. We computed multivariate incidence rate ratios adjusting for baseline age, gender, smoking, physical activity, waist circumference, and hypertension status. Participants with systolic blood pressure variability ≥10 mmHg compared to those with <10 mmHg, showed higher progression to pre-diabetes/diabetes (RR = 1.77, 95% CI: 1.30–2.42). The association persisted among never smokers. Diastolic blood pressure variability ≥10 mmHg (compared to <10 mmHg) did not show an association with diabetes status progression (RR = 1.20, 95% CI: 0.71–2.01). Additional adjustment of baseline glycemia, C-reactive protein, and lipids (reported dyslipidemia or baseline HDL or triglycerides) did not change the estimates. Systolic blood pressure variability may be a novel independent risk factor and an early predictor for diabetes, which can be easily incorporated into a single routine outpatient visit at none to minimal additional cost.

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Acknowledgements

We acknowledge the SOALS team (Dr. O.M. Andriankaja, PhD, DDS; Ms. T. Ginebra, RN; Ms. C. León, MPH; Ms. Y. Maldonado, BS; Dr. S. Martinez, PhD; Ms. X. O’Farrill; Ms. S. Ordaz, BS; Dr. C. Perez, PhD; Ms. E. Rodriguez, MT; Ms. R. Roman, MT; Mr. R. Ruiz, BS; Ms. Y. Santaella, RN; Ms. G. Velez, BS; Mr. J. Vergara, BS; Ms. L. Wah, MPH; Mr. J. Fernández) and PRCTRC laboratory personnel (Ms. A. Arroyo, MS, HIM, MT and Ms. N. Gonzalez, MS, MT) who contributed to the conduct/oversight/planning of data collection, and Ms. K. Giovannetti, MPH, MS for conducting a program review, for their help with the study. Research reported in this publication was supported by the National Institute of Dental and Craniofacial Research Grant R01DE020111 and the National Institute on Minority Health and Health Disparities Grant 2U54MD007587 of the National Institutes of Health.

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Authors and Affiliations

  1. Center for Clinical Research and Health Promotion, University of Puerto Rico Medical Sciences Campus, School of Dental Medicine, San Juan, PR, USA

    Kaumudi J. Joshipura, Francisco J. Muñoz-Torres, Maribel Campos & Alba D. Rivera-Díaz

  2. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Kaumudi J. Joshipura

  3. Department of Medical and Population Sciences Research, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA

    Juan C. Zevallos

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  1. Kaumudi J. Joshipura
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Correspondence to Kaumudi J. Joshipura.

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Joshipura, K.J., Muñoz-Torres, F.J., Campos, M. et al. Association between within-visit systolic blood pressure variability and development of pre-diabetes and diabetes among overweight/obese individuals. J Hum Hypertens 32, 26–33 (2018). https://doi.org/10.1038/s41371-017-0009-y

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