Elderly Diabetics Decrease Mortality by Monitoring Blood Pressure

Ambulatory blood pressure (BP) monitoring of the elderly diabetic can improve the prediction of Heart Disease and Mortality

In a study of 1,178 diabetics with an average age of 70 years, Dr. Walter Palmas at Columbia University in New York, New York, and colleagues analyzed the relationship between data from baseline ambulatory BP monitoring and mortality during a mean follow-up period of 6.6 years.

There were 278 deaths, with cause of death recorded in 215 cases. Approximately half, 110 deaths, had a cardiovascular cause.

According to the researchers’ paper in the February issue of Hypertension, albuminuria and office heart rate (HR) were independent predictors of all-cause and cardiovascular mortality in models using clinical and laboratory data.

“When ambulatory monitoring data were added, sleep:wake HR ratio and ambulatory arterial stiffness index added significantly to the prediction of all-cause mortality, but only sleep:wake HR ratio added to the prediction of cardiovascular mortality,” the researchers report. They add that office HR and albuminuria retained their significance as predictors for cardiovascular and all-cause mortality.

The investigators also found that 24-hour pulse pressure and sleep systolic BP were independent predictors of all-cause and cardiovascular mortality, respectively.

“Albuminuria, a powerful marker of increased risk, may mediate the association between elevated BP and higher mortality,” they suggest.

“Our study adds to the evidence supporting the use of ambulatory blood pressure monitoring to predict mortality risks,” Dr. Palmas told Reuters Health. “It also highlights the importance of heart rate as a predictor of risk — unfortunately, heart rate has often been ignored in predictive models.”

“Overall, we believe that our findings highlight the relationship between diabetic end-organ damage, as reflected by changes in HR, BP, and albuminuria, and the mortality risks in elderly people with diabetes mellitus.”

“Treatment implications are limited, because this is an observational study,” Dr. Palmas pointed out. “But our findings suggest that ambulatory blood pressure monitoring may help physicians identify patients who are at higher risk, and who thus may benefit from more intensive management of their cardiovascular risk factors.”

“Our findings do support the use of overnight monitoring,” he added. “Our next goal is to compare self-monitoring of blood pressure, which is more economic and widely used but does not include overnight evaluation, to ambulatory blood pressure monitoring as tools to predict mortality risks in people with diabetes.”
Hypertension 2009; 53:120-127.