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Long-term variability and change trend of systolic blood pressure and risk of type 2 diabetes mellitus in middle-aged Japanese individuals: findings of the Aichi Workers’ Cohort Study


Studies have reported that short-term blood pressure (BP) variability (BPV) is associated with type 2 diabetes mellitus (T2DM) incidence, but the association with long-term BPV remains unclear. The present study investigated the associations of long-term BPV as well as the time trend of BP changes over time with the incidence of T2DM. This study followed a cohort of 3017 Japanese individuals (2446 male, 571 female) aged 36–65 years from 2007 through March 31, 2019. The root-mean-square error (RMSE) and the slope of systolic BP (SBP) change regressed on year were calculated individually using SBP values obtained from 2003 to baseline (2007). A multivariable Cox proportional hazard model was applied to estimate hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) for tertiles of SBP RMSE and continuous SBP slopes adjusted for age, sex, smoking status, regular exercise, sodium intake, family history of diabetes, sleep disorder, body mass index (BMI), SBP, and fasting blood glucose (FBG) at baseline, and BMI slope from 2003 to 2007. The highest RMSE tertile compared to the lowest was associated with a significantly higher incidence of T2DM after adjusting for covariates (HR: 1.79, 95% CI: 1.15, 2.78). The slope was also significantly associated with T2DM incidence until baseline SBP and FBG were adjusted (HR: 1.03, 95% CI: 0.99, 1.07). In conclusion, long-term SBP variability was significantly associated with an increased incidence of T2DM independent of baseline age, sex, BMI, SBP, FBG, lifestyle factors and BMI slope from 2003 until baseline.

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The authors would like to thank the participants and health care personnel of the local government office, the technical assistance of Mr. Hidetoshi Ichimura, and Professor Emeritus Hideaki Toyoshima who founded the Aichi Workers' Cohort Study. The author (ZS) also thanks the “Nagoya University Interdisciplinary Frontier Fellowship” sponsored by Japan Science and Technology (JST) and Nagoya University for the support.


This work was supported in part by MEXT/JSPS KAKENHI (grant numbers 09470112, 13470087 and 17390185 to Hideaki Toyoshima; 13770192, 15689011, 17790384, 20790438, 22390133, 23659346, 26293153 18H03057 and 22H03349 to HY; 12670352, 16590499, 18590594, 20590641, 23590787, 15K08802 and 20K10496 to KT; 25893088, 16K19278 and 19K19419 to YL); Health and Labor Sciences research grants for Comprehensive Research on Cardiovascular and Life-Style Related Diseases (H26-Junkankitou [Seisaku]-Ippan-001, H29-Junkankitou [Seishuu]-Ippan-003, and 20FA1002) from the Ministry of Health, Labor and Welfare; and research grants from the Japan Atherosclerosis Prevention Fund, the Aichi Health Promotion Foundation, the Uehara Memorial Fund, and fund from the Noguchi Memorial Research Institute.

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Correspondence to Hiroshi Yatsuya.

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Song, Z., He, Y., Chiang, C. et al. Long-term variability and change trend of systolic blood pressure and risk of type 2 diabetes mellitus in middle-aged Japanese individuals: findings of the Aichi Workers’ Cohort Study. Hypertens Res 45, 1772–1780 (2022).

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  • Blood pressure variability
  • Cohort study
  • Type 2 diabetes mellitus

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