Elly Budiman-Mak1, Noam Epstein2, Meghan Brennan3, Rodney Stuck1, Marylou Guihan4, Zhiping Huo2, Nicholas Emanuele1, Min-Woong Sohn5. 1. Hines VA Hospital, 5000 South 5th Avenue, Hines, IL 60141, USA; Stritch School of Medicine, Loyola University Chicago, 2160 South 1st Avenue, Maywood, IL 60153, USA. 2. Hines VA Hospital, 5000 South 5th Avenue, Hines, IL 60141, USA. 3. Middleton VA Medical Center, 2500 Overlook Terrace, Madison, WI 53705, USA; School of Medicine and Public Health, University of Wisconsin, 750 Highland Avenue, Madison, WI 53726, USA. 4. Hines VA Hospital, 5000 South 5th Avenue, Hines, IL 60141, USA; Department of Physical Medicine and Rehabilitation and Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. 5. Department of Public Health Sciences, University of Virginia School of Medicine, Hospital West, 3rd Floor, RM 3181, Charlottesville, VA 22908, USA. Electronic address: msohn@virginia.edu.
Abstract
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.
RCT Entities:
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.
Authors: Michal Dubský; Alexandra Jirkovská; Robert Bem; Vladimira Fejfarová; Jelena Skibová; Nicolaas C Schaper; Benjamin A Lipsky Journal: Int Wound J Date: 2012-06-19 Impact factor: 3.315
Authors: Jun Hata; Hisatomi Arima; Peter M Rothwell; Mark Woodward; Sophia Zoungas; Craig Anderson; Anushka Patel; Bruce Neal; Paul Glasziou; Pavel Hamet; Giuseppe Mancia; Neil Poulter; Bryan Williams; Stephen Macmahon; John Chalmers Journal: Circulation Date: 2013-08-07 Impact factor: 29.690
Authors: Meghan B Brennan; Marylou Guihan; Elly Budiman-Mak; Hyojung Kang; Jennifer M Lobo; Bryn L Sutherland; Nicholas Emanuele; Elbert S Huang; Min-Woong Sohn Journal: J Hypertens Date: 2018-11 Impact factor: 4.844