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Blood pressure trajectories prior to death in patients with diabetes.

Rogers MA, Ward K, Gure TR, Choe HM, Lee PG, Bernstein SJ, Blaum CS - Diabetes Care (2011)

Bottom Line: The crude and adjusted models both showed a greater decline in systolic and diastolic BP in patients who died than in those who did not die.In a model adjusted for age, sex, race, medications, and comorbidities, the mean systolic BP decreased by 3.2 mmHg/year (P<0.001) in the years before death and by 0.7 mmHg/year (P<0.001) in those who did not die (P<0.001 for the difference in slopes).Similarly, diastolic BP declined by 1.3 mmHg/year for those who died (P<0.001) and by 0.6 mmHg/year for those who did not die (P<0.001); the difference in slopes was significant (P=0.021).

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA. maryroge@umich.edu

ABSTRACT

Objective: The goals of this study were to examine trajectories of blood pressure (BP) in adults with diabetes and investigate the association of trajectory patterns with mortality.

Research design and methods: A nonconcurrent longitudinal design was used to monitor 3,766 Medicare patients with diabetes from 2005 through 2008. Data were extracted from a registry of Medicare beneficiaries, which was developed by a large academic practice that participated in the Physician Group Practice Medicare Demonstration. The relationship between BP trajectories and all-cause mortality was modeled using multilevel mixed-effects linear regression.

Results: During the 4-year study period, 10.7% of the patients died, half of whom were aged≥75 years. The crude and adjusted models both showed a greater decline in systolic and diastolic BP in patients who died than in those who did not die. In a model adjusted for age, sex, race, medications, and comorbidities, the mean systolic BP decreased by 3.2 mmHg/year (P<0.001) in the years before death and by 0.7 mmHg/year (P<0.001) in those who did not die (P<0.001 for the difference in slopes). Similarly, diastolic BP declined by 1.3 mmHg/year for those who died (P<0.001) and by 0.6 mmHg/year for those who did not die (P<0.001); the difference in slopes was significant (P=0.021).

Conclusions: Systolic and diastolic BP both declined more rapidly in the 4 years before death than in patients who remained alive.

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Mean systolic and diastolic BP trajectories for patients with diabetes mellitus, by sex and mortality.
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Figure 2: Mean systolic and diastolic BP trajectories for patients with diabetes mellitus, by sex and mortality.

Mentions: Systolic and diastolic BP both significantly declined before death in patients with diabetes. In an unadjusted model, mean systolic BP declined 3.1 mmHg (95% CI 1.9–4.3) and mean diastolic BP declined 1.6 mmHg (0.9–2.3) annually before death. In the adjusted model (Table 2), systolic pressure decreased by 3.2 mmHg/year (P < 0.001) in those who died and by 0.7 mmHg/year (P < 0.001) in those who did not die (P < 0.001 for the difference in slopes between trajectories). Diastolic pressure declined by 1.3 mmHg/year for those who died (P < 0.001) and by 0.6 mmHg/year for those who did not die (P < 0.001); the difference in slopes remained significant (P = 0.021). The addition of a quadratic term to detect a nonlinear change in slope was not significant for systolic (P = 0.965) or diastolic BP (P = 0.761) in the adjusted models. BP trajectories generated from the adjusted models are shown in Fig. 1 and Fig. 2, with stratification by mortality.


Blood pressure trajectories prior to death in patients with diabetes.

Rogers MA, Ward K, Gure TR, Choe HM, Lee PG, Bernstein SJ, Blaum CS - Diabetes Care (2011)

Mean systolic and diastolic BP trajectories for patients with diabetes mellitus, by sex and mortality.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3120174&req=5

Figure 2: Mean systolic and diastolic BP trajectories for patients with diabetes mellitus, by sex and mortality.
Mentions: Systolic and diastolic BP both significantly declined before death in patients with diabetes. In an unadjusted model, mean systolic BP declined 3.1 mmHg (95% CI 1.9–4.3) and mean diastolic BP declined 1.6 mmHg (0.9–2.3) annually before death. In the adjusted model (Table 2), systolic pressure decreased by 3.2 mmHg/year (P < 0.001) in those who died and by 0.7 mmHg/year (P < 0.001) in those who did not die (P < 0.001 for the difference in slopes between trajectories). Diastolic pressure declined by 1.3 mmHg/year for those who died (P < 0.001) and by 0.6 mmHg/year for those who did not die (P < 0.001); the difference in slopes remained significant (P = 0.021). The addition of a quadratic term to detect a nonlinear change in slope was not significant for systolic (P = 0.965) or diastolic BP (P = 0.761) in the adjusted models. BP trajectories generated from the adjusted models are shown in Fig. 1 and Fig. 2, with stratification by mortality.

Bottom Line: The crude and adjusted models both showed a greater decline in systolic and diastolic BP in patients who died than in those who did not die.In a model adjusted for age, sex, race, medications, and comorbidities, the mean systolic BP decreased by 3.2 mmHg/year (P<0.001) in the years before death and by 0.7 mmHg/year (P<0.001) in those who did not die (P<0.001 for the difference in slopes).Similarly, diastolic BP declined by 1.3 mmHg/year for those who died (P<0.001) and by 0.6 mmHg/year for those who did not die (P<0.001); the difference in slopes was significant (P=0.021).

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA. maryroge@umich.edu

ABSTRACT

Objective: The goals of this study were to examine trajectories of blood pressure (BP) in adults with diabetes and investigate the association of trajectory patterns with mortality.

Research design and methods: A nonconcurrent longitudinal design was used to monitor 3,766 Medicare patients with diabetes from 2005 through 2008. Data were extracted from a registry of Medicare beneficiaries, which was developed by a large academic practice that participated in the Physician Group Practice Medicare Demonstration. The relationship between BP trajectories and all-cause mortality was modeled using multilevel mixed-effects linear regression.

Results: During the 4-year study period, 10.7% of the patients died, half of whom were aged≥75 years. The crude and adjusted models both showed a greater decline in systolic and diastolic BP in patients who died than in those who did not die. In a model adjusted for age, sex, race, medications, and comorbidities, the mean systolic BP decreased by 3.2 mmHg/year (P<0.001) in the years before death and by 0.7 mmHg/year (P<0.001) in those who did not die (P<0.001 for the difference in slopes). Similarly, diastolic BP declined by 1.3 mmHg/year for those who died (P<0.001) and by 0.6 mmHg/year for those who did not die (P<0.001); the difference in slopes was significant (P=0.021).

Conclusions: Systolic and diastolic BP both declined more rapidly in the 4 years before death than in patients who remained alive.

Show MeSH
Related in: MedlinePlus