Blood pressure variables and cardiovascular risk in type 2 diabetes in the ADVANCE trial

The relative importance of different indices of blood pressure on cardiovascular risk in type 2 diabetes has not been established. The present study compared the relationships between different parameters of blood pressure (systolic blood pressure [SBP], diastolic blood pressure [DBP], pulsed pressure [PP] and mean blood pressure [MBP], and the risk of major adverse cardiovascular events at 4.3 years in the Action in Diabetes and Vascular Disease: Preterax and Diamicron-Modified Release Controlled Evaluation (ADVANCE) trial. The mean age of the 11 140 participants was 65.8 (6.4) years. During follow-up, 1 000 major adverse cardiovascular events, 559 major coronary events and 468 cardiovascular deaths were registered. After adjustment for age, sex and randomisation group, the hazard ratios (95% confidence intervals) associated with increased deviation from the standard for the risk of major adverse cardiovascular events were 1.17 (1.10 to 1.24) for SBP, 1.20 (1.13 to 1.28) for PP, 1.12 (1.05 to 1.19) for MBP, and 1.04 (0.98 to 1.11) for DBP. The areas under the ROC curve were higher for SBP and PP compared with DBP and MBP for major adverse cardiovascular events and major coronary events. When MBP was used during follow-up instead of basal blood pressure values, there was marginal improvement of the estimation of SBP, DBP and MBP, but without significant differences in areas under the ROC curve between models of SBP and those of PP. In conclusion, SBP and PP are the two best and DBP the least predictive parameters of the risk of cardiovascular events in the ADVANCE population of patients, who were relatively elderly with type 2 diabetes. However, SBP would be the simplest and most useful predictive factor in all age groups and populations.