Blood pressure variability in individuals with diabetes <i>mellitus</i>: a scoping review

Silva, Antonia Fabiana Rodrigues da; Cruz, Rebeca Chaves; Albuquerque, Nila Larisse Silva de; Silva, Viviane Martins da; Araujo, Thelma Leite de

doi:10.1590/0034-7167-2021-0804

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Revista Brasileira de Enfermagem

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REVIEW • Rev. Bras. Enferm. 75 (06) • 2022 • https://doi.org/10.1590/0034-7167-2021-0804 copy

Blood pressure variability in individuals with diabetes mellitus: a scoping review

Variabilidad de la presión arterial en individuos con diabetes mellitus: revisión del área

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives:

to map methods and devices used to assess very short-, short-, medium-, and long-term pressure variability in adults with type 1 or 2 diabetes mellitus.

Methods:

scoping review conducted in January and February 2021 in MEDLINE, Web of Science, CINAHL, LILACS, PubMed, and Embase databases. Studies conducted within the last ten years analyzing pressure variability in adult and older patients with diabetes mellitus type 1 or 2 were included. Studies that used discontinued devices were excluded.

Results:

the sample was composed of 25 articles published since 2017, with the majority developed in Japan (n=11); with the predominance of the oscillometric method (n=22); the most used devices were from the Omron^® brand (n=14); the most detected type was long-term variability (n=10).

Conclusions:

we observed the increasing application of the oscillometric method for pressure variability analysis with various brands and models of automatic devices.

Descriptors:
Blood Pressure Determination; Blood Pressure; Diabetes Mellitus; Adult; Older Adult

LILACS^* * Latin American and Caribbean Literature in Health Sciences;	PubMed^ National Library of Medicine; / Web of science/Scopus/Embase	CINAHL^ National Library of Medicine; ^* * Latin American and Caribbean Literature in Health Sciences;
(Diabetes Mellitus OR Diabetes Mellitus Type 2 OR Diabetes Mellitus Type 1 OR Diabetes) AND (“Blood Pressure” OR “Blood Pressure” OR “Blood Pressure Variability”)	(Diabetes Mellitus OR Diabetes Mellitus, Type 2 OR Diabetes Mellitus, Type 1 OR Diabetes) AND (“Blood Pressure Variability”)	(Diabetes Mellitus OR Diabetes Mellitus, Type 2 OR Diabetes Mellitus, Type 1 OR Diabetes) AND (“Blood Pressure Variability”)

Main author/ /year/country	Objective	Study design/ participants /Type of DM	Method	Device	Type of BPV /interval of measurements
Najafi MT (2018)(²¹21 Najafi MT, Khaloo P, Alemi H, Jaafarinia A, Blaha MJ, Mirbolouk M, et al. Ambulatory blood pressure monitoring and diabetes complications: targeting morning blood pressure surge and nocturnal dipping. Medicine (Baltimore). 2018;97(38):e12185. https://doi.org/10.1097/MD.0000000000012185 https://doi.org/10.1097/MD.0000000000012... ) Iran	To investigate the association between microvascular and macrovascular diabetes complications and diurnal and nocturnal BP variability.	Cross-sectional/ 192 participants/ DM 2	Auscultatory Oscillometric	Mercury Sphygmomanometer Erkameter 3000^® ABPM Tiba Ambulo 2400^®	Short-term/ Every 30 minutes for 24 hours ^ Number of measurements not informed. One measurement at a time, every 30 consecutive minutes, for a period of 24 hours
Iuchi H (2017)(²²22 Iuchi H, Sakamoto M, Matsutani D, Suzuki H, Kayama Y, Takeda N, et al. Association between day-by-day and ambulatory blood pressure variability in type 2 diabetes patients. Blood Press Monit. 2017;22(6):351-354. https://doi.org/10.1093/ajh/hpaa091 https://doi.org/10.1093/ajh/hpaa091... ) Japan	To examine the association between daily BPV and two different types of ambulatorial BPV.	Cross-sectional/ 30 participants/ DM2	Oscillometric	TM-242\5; A&D (ABPM)^®^* * Validation status not reported;	Short- (24 hours) and medium- term (five days) One measurement every visit for five days One measurement every 60 minutes for 24 hours, during daytime (9:00 am to 9:00 pm) and night-time (00:00 am to 06:00 am)
Wan EYF (2017)(²³23 Wan EY, Fung CS, Yu EY, Fong DY, Chen JY, Lam CL. Association of visit-to-visit variability of systolic blood pressure with cardiovascular disease and mortality in primary care Chinese patients with type 2 diabetes-a retrospective population-based cohort study. Diabetes Care. 2017;40(2):270-9. https://doi.org/10.2337/dc16-1617 https://doi.org/10.2337/dc16-1617... ) China	To evaluate the connection between visit-to-visit variability of SBP and CVD/mortality risk in the Chinese DM2 population in primary care.	Retrospective cohort/ 124,105 participants/ type 2 DM	Oscillometric	TM-2655P, A&D Company^® UA-853, A&D Company^® M3A, EDAN^®^* * Validation status not reported;	Long-term (visit-to-visit) / two years Every three months (a total of nine)
Suzuki D (2020)(²⁴24 Suzuki D, Hoshide S, Kario K. Associations Between Day-by-Day Home Blood Pressure Variability and Renal Function and Albuminuria in Patients With and Without Diabetes. Am J Hypertens. 2020;33(9):860-8. https://doi.org/10.1093/ajh/hpaa091 https://doi.org/10.1093/ajh/hpaa091... ) Japan	To investigate the association between daily BPV at home and eTFG in individuals with diabetes and compare this connection with individuals without diabetes.	Cross-sectional J-HOP study/ 4,231 participants/ Type of DM not reported	Oscillometric	HEM-5001, Omron Healthcare^®^* * Validation status not reported;	Medium-term (visit-to-visit) / 14 days One measurement in the morning and at night
Veloudi P (2016)(²⁵25 Veloudi P, Blizzard L, Srikanth VK, McCartney P, Lukoshkova EV, Hughes AD, et al. Associations of blood pressure variability and retinal arteriolar diameter in participants with type 2 diabetes. Diab Vasc Dis Res. 2016;13(4):299-302. https://doi.org/10.1177/1479164116633424 https://doi.org/10.1177/1479164116633424... ) Australia	To determine the relation between BPV indices and retinal arteriolar diameter in non-diabetic participants and participants with type II diabetes.	Post-hoc analysis/ 35 non-diabetic and 28 DM2 participants	Oscillometric	TM-2430, A&D Medical^®	Short-term/24 hours Every 20 minutes during the day and every 30 minutes at night
Papadopoulou E. (2020)(²⁶26 Papadopoulou E, Theodorakopoulou MP, Loutradis C, Tzanis G, Tzatzagou G, Kotsa K, et al. Dapagliflozin does not affect short-term blood pressure variability in patients with type-2 diabetes mellitus. Am J Hypertens. 2020;34(4):404-13. https://doi.org/10.1093/ajh/hpaa207 https://doi.org/10.1093/ajh/hpaa207... ) Greece	To evaluate the effect of dapagliflozin on short-term BPV in patients with DM2.	Randomized clinical trial/ 43 participants in the dapagliflozin group and 42 in the placebo group/ type 2 DM	Oscillometric	Mobil-O-Graph, IEM-Stolberg^®	Short-term/24 hours 20 minutes during the day (7am to 11pm) and every 30 minutes during the night (11pm to 7am).
Y. Gepner, Y (2016)(²⁷27 Gepner Y, Henkin Y, Schwarzfuchs D, Golan R, Durst R, Shelef I, et al. Differential Effect of Initiating Moderate Red Wine Consumption on 24-h Blood Pressure by Alcohol Dehydrogenase Genotypes: randomized trial in Type 2 Diabetes. Am J Hypertens. 2016;29(4):476-83. https://doi.org/10.1093/ajh/hpv126 https://doi.org/10.1093/ajh/hpv126... ) Israel	To evaluate the effect of initiating moderate red wine consumption on 24-hour BP recordings and the effect of one common alcohol dehydrogenase (ADH) genetic variant among patients with type 2 diabetes.	Randomized clinical trial/ 224 patients/ DM2	Oscillometric	Oscar 2, SunTech Medical^®	Short-term/24 hours (At the beginning and end of the study) Every 30 minutes during the day (6am to 11pm) and every 60 minutes at night (11pm to 6am)
Ushigome E (2014)(²⁸28 Ushigome E, Fukui M, Hamaguchi M, Tanaka T, Atsuta H, Mogami SI, et al. Factors affecting variability in home blood pressure in patients with type 2 diabetes: post hoc analysis of a cross-sectional multicenter study. J Hum Hypertens. 2014;28(10):594-9. https://doi.org/10.1038/jhh.2014.2 https://doi.org/10.1038/jhh.2014.2... ) Japan	Investigate the factors affecting BPV at home in patients with DM2.	Cross-sectional Multicenter study/ 1,114 participants: 608 males and 506 females/ type 2 DM	Oscillometric	HEM-70801C, Omron Healthcare^®	Medium-term/ 14 days Three measurements in the morning and evening for 24 hours
Foo V (2017)(²⁹29 Foo V, Quah J, Cheung G, Tan NC, MaZar KL, Chan CM, et al. HbA1c, systolic blood pressure variability and diabetic retinopathy in Asian type 2 diabetics. J Diabetes. 2017;9(2):200-7. https://doi.org/10.1111/1753-0407.12403 https://doi.org/10.1111/1753-0407.12403... ) Singapore	To determine whether HbA1c and SBP variability, assessed retrospectively based on regular, consecutive HbA1c and SBP values obtained over two years prior to the onset of moderate diabetic retinopathy, was independently associated with moderate retinopathy-specific diabetes.	Retrospective case-control study/ 398 participants/ DM2	Auscultatory	Aneroid Sphygmomanometer Series Six00; Accoson^®^* * Validation status not reported;	Long-term/two Years Three to five measurements every three months
Kalinga BE (2019)(³⁰30 Kalinga BE, Chethan Y. High-Sensitivity C-Reactive Protein and 24-Hours Ambulatory Blood Pressure Variability in Type 2 Diabetes Mellitus Patients. J Clin Diagnostic Res. 2019;13(3):OC04-OC07. https://doi.org/10.7860/JCDR/2019/40065.12691 https://doi.org/10.7860/JCDR/2019/40065.... ) India	Compare the BPV with inflammation marker (Hs-CRP) to study the impact of the effect of BPV in patients with diabetes on vascular endothelium cells using 24-hour ABPM.	Case-control/ 100 Participants: 50 with DM2 and 50 without DM2	Oscillometric	Pressurometer P6; Del Mar Reynold^®	Short-term/24 hours Every 30 min (7am to 10pm) and 60 min (10pm to 7am)
Ciobanu DM (2016)(³¹31 Ciobanu DM, Bala CG, Veresiu IA, Mircea PA, Roman G. High-sensitivity C-reactive protein is associated with 24-hour ambulatory blood pressure variability in type 2 diabetes and control subjects. Revista Română de Medicină de Laborator. 2016; 24 (1). https://doi.org/https://doi.org/10.1515/rrlm-2016-0013 https://doi.org/https://doi.org/10.1515/... ) Romania	To evaluate the connection between high-sensitivity C-reactive protein (hsCRP) and BPV during 24-hour ambulatory BP monitoring in DM2 and healthy control individuals.	Cross-sectional/ 75 participants/ type 2 DM	Oscillometric	HolCard CR-07, Aspel^®	Short-term/24h Every 30 min (7am to 10pm) and 60 min (10pm to 7am)
Fukui M (2013)(³²32 Fukui M, Ushigome E, Tanaka M, Hamaguchi M, Tanaka T, Atsuta H, et al. Home blood pressure variability on one occasion is a novel factor associated with arterial stiffness in patients with type 2 diabetes. Hypertens Res. 2013; 36(3):219-25. https://doi.org/10.1038/hr.2012.177 https://doi.org/10.1038/hr.2012.177... ) Japan	To investigate the connection between BPV on one occasion and markers of arterial stiffness in patients with type 2 diabetes.	Cross-sectional Multicenter study/ 332 participants/ type 2 DM	Oscillometric	HEM-70801C, Omron Healthcare^®	Medium-term/14 days Three measurements in the morning and night over 24 hours
Ciobanu DM (2019)(³³33 Ciobanu DM, Mircea PA, Bala C, Rusu A, Vesa Ş, Roman G. Intercellular adhesion molecule-1 (ICAM-1) associates with 24-hour ambulatory blood pressure variability in type 2 diabetes and controls. Cytokine. 2019;116:134-138. https://doi.org/10.1016/j.cyto.2019.01.006 https://doi.org/10.1016/j.cyto.2019.01.0... ) Romania	To evaluate the connection between circulating adhesion molecules and ambulatory blood pressure variability in patients with type 2 diabetes and controls.	Cross-sectional/ 110 participants in two groups: controlled BP (n = 55) and non-controlled BP (n= 55)/Type 2 DM	Oscillometric	HolCard CR-07, Aspel^®	Short-term/24h Every 30 min during the day (7am to 10pm) and every 60 min at night (10pm to 7am)
Matsumoto S (2014)(³⁴34 Matsumoto S, Fukui M, Hamaguchi M, Ushigome E, Matsushita K, Fukuda T, et al. Is home blood pressure reporting in patients with type 2 diabetes reliable? Hypertens Res. 2014;37(8):741-5. https://doi.org/10.1038/hr.2014.66 https://doi.org/10.1038/hr.2014.66... ) Japan	To evaluate the reliability of home blood pressure (HBP) in patients with type 2 diabetes by comparing self-reported values with HBP measurements stored in the memory of the blood pressure (BP) monitor.	Cross-sectional/ 280 Participants/ type 2 DM	Oscillometric	HEM-7080IC, Omron Healthcare^®	Medium-term/14 days Triplicate measurements in the morning and at night
Cardoso CRL (2020)(³⁵35 Cardoso C, Leite NC, Salles GF. Prognostic importance of visit-to-visit blood pressure variability for micro- and macrovascular outcomes in patients with type 2 diabetes: the Rio de Janeiro Type 2 Diabetes Cohort Study. Cardiovasc Diabetol. 2020;19(1):50. https://doi.org/10.1186/s12933-020-01030-7 https://doi.org/10.1186/s12933-020-01030... ) Brazil	To investigate whether long-term visit-to-visit BPV (BP-VVV) impacts the prognosis for microvascular and macrovascular complications, developmental actions, and all-cause mortality.	Prospective cohort/ 632 participants/ type 2 DM	Oscillometric	HEM-907XL, Omron Healthcare^®	Long-term (visit-to-visit) /24 months Three to four annual measurements
E. Ushigome (2018)(³⁶36 Ushigome E, Matsumoto S, Oyabu C, Kitagawa N, Tanaka T, Hasegawa G, et al. Prognostic significance of day-by-day variability of home blood pressure on progression to macroalbuminuria in patients with diabetes. J Hypertens. 2018;36(5):1068-1075. https://doi.org/10.1097/HJH.0000000000001657 https://doi.org/10.1097/HJH.000000000000... ) Japan	To clarify whether daily home systolic blood pressure (HSBP) variability could have a significant prognostic role in the progression to macroalbuminuria in a prospective two-year study.	Prospective cohort/ 714 participants/ type 2 DM	Oscillometric	HEM-70801C, Omron Healthcare^®	Medium-term/14 days. Triplicate measurements in the morning and at night.
T. Takao (2015)(³⁷37 Takao T, Kimura K, Suka M, Yanagisawa H, Kikuchi M, Kawazu S, et al. Relationships between the risk of cardiovascular disease in type 2 diabetes patients and both visit-to-visit variability and time-to-effect differences in blood pressure. J Diabetes Complications. 2015;29(5):699-706. https://doi.org/10.1016/j.jdiacomp.2015.03.010 https://doi.org/10.1016/j.jdiacomp.2015.... ) Japan	To determine whether visit-to-visit BPV can predict cardiovascular disease (CVD) incidence in patients with DM2, independent of mean BP, and to analyze the time-effect connection between BP and CVD risk..	Retrospective cohort/ 629 participants/ type 2 DM	Oscillometric	BP-10, Omron Healthcare^®	Long-term (visit-to-visit) / 11 years ^ Number of measurements not informed.
Hashimoto, Y (2018)(³⁸38 Hashimoto Y, Kaji A, Sakai R, Hamaguchi M, Okada H, Ushigome E, et al. Sarcopenia is associated with blood pressure variability in older patients with type 2 diabetes: a cross-sectional study of the KAMOGAWA-DM cohort study. Geriatr Gerontol Int. 2018;18(9):1345-9. https://doi.org/10.1111/ggi.13487 https://doi.org/10.1111/ggi.13487... ) Japan	Investigate the connection between sarcopenia and blood pressure parameters, including BPV visit-to-visit to elderly patients with type 2 diabetes.	Cross-sectional with data from a cohort study/ 209 participants/ type 2 DM	Oscillometric	HEM-906, Omron Healthcare^®^* * Validation status not reported;	Long-term (visit-to-visit)/one year ^ Number of measurements not informed.
Ushigome E (2011)(³⁹39 Ushigome E, Fukui M, Hamaguchi M, Senmaru T, Sakabe K, Tanaka M, et al. The coefficient variation of home blood pressure is a novel factor associated with macroalbuminuria in type 2 diabetes mellitus. Hypertens Res. 2011;34(12):1271-5. https://doi.org/10.1038/hr.2011.128 https://doi.org/10.1038/hr.2011.128... ) Japan	To investigate the connection between the variability of daily home blood pressure over 14 consecutive days and macroalbuminuria in patients with type 2 diabetes.	Cross-sectional Multicenter study/ 858 participants/ type 2 DM	Oscillometric	HEM-70801C, Omron Healthcare^®	Medium-term (visit-to-visit) /14 days. Three measurements in the morning and at night for 14 days
Bhardwaj S (2014)(⁴⁰40 Bhardwaj S, Verma N, Anjum B, Bhardwaj K. Variations in 7-day/24-h circadian pattern of ambulatory blood pressure and heart rate of type 2 diabetes patients. J Diabetes Investig. 2014;5(6):728-33. https://doi.org/10.1111/jdi.12224 https://doi.org/10.1111/jdi.12224... ) Índia	To evaluate the 7-day/24-hour circadian pattern of BP and heart rate in diabetic patients to help diagnose and prevent cardiovascular morbidity.	Case-control/ 100 participants (50 males with type 2 DM and 50 males without diabetes)	Oscillometric	A&D TM-2430, A&D Company^®	Short-term/24-hour BP for seven days Every 30 minutes during the day and 60-minute intervals during the night
Radaelli MG (2020)(⁴¹41 Radaelli MG, Ciardullo S, Perra S, Cannistraci R, Bianconi E, Muraca E, et al. Visit-to-visit blood pressure variability in patients with type 2 diabetes with and without previous history of cardiovascular disease. J Hypertens. 2020;38(9):1737-44. https://doi.org/10.1097/HJH.0000000000002443 https://doi.org/10.1097/HJH.000000000000... ) Italy	To retrospectively assess the coefficient of variation of mean SBP and its connection with CVD prevalence and risk of future CVD-related events using the ten-year UKPDS Risk Engine.	Cross-sectional, retrospective/ 970 medical charts	Oscillometric	Omron M6, Omron Healthcare^®	Long-term/two years ^ Number of measurements not informed.
Okada H (2013)(⁴²42 Okada H, Fukui M, Tanaka M, Matsumoto S, Mineoka Y, Nakanishi N, et al. Visit-to-visit blood pressure variability is a novel risk factor for the development and progression of diabetic nephropathy in patients with type 2 diabetes. Diabetes Care. 2013;36(7):1908-12. https://doi.org/10.2337/dc12-2087 https://doi.org/10.2337/dc12-2087... ) Japan	To investigate the connection between visit-to-visit variability in SBP and alteration in urinary albumin excretion (UAE) or development of albuminuria in patients with type 2 diabetes.	Retrospective cohort/ 354 patients/ Type 2 DM	Oscillometric	HEM-906, Omron Healthcare^®^* * Validation status not reported;	Long-term (visit-to-visit)/one year ^ Number of measurements not informed.
Noshad S (2014)(⁴³43 Noshad S, Mousavizadeh M, Mozafari M, Nakhjavani M, Esteghamati A. Visit-to-visit blood pressure variability is related to albuminuria variability and progression in patients with type 2 diabetes. J Hum Hypertens. 2014;28:37-43. https://doi.org/10.1038/jhh.2013.36 https://doi.org/10.1038/jhh.2013.36... ) Iran	To investigate whether variability in BP between visits is a significant predictor of progression to microalbuminuria independent of mean BP..	Retrospective cohort/ 194 medical charts/ DM2	Auscultatory	Riester Big Ben^®, Jungingen ^* * Validation status not reported;	Long-term/ 24 to 48 months ^ Number of measurements not informed.
Hsieh YT (2012)(⁴⁴44 Hsieh YT, Tu ST, Cho TJ, Chang SJ, Chen JF, Hsieh MC. Visit-to-visit variability in blood pressure strongly predicts all-cause mortality in patients with type 2 diabetes: a 5·5-year prospective analysis. Eur J Clin Invest. 2012;42(3):245-53. https://doi.org/10.1111/j.1365-2362.2011.02574.x https://doi.org/10.1111/j.1365-2362.2011... ) Taiwan	To evaluate the connection between all-cause mortality and blood pressure parameters (systolic blood pressure [SBP], diastolic blood pressure [DBP], pulse pressure [PP], mean arterial pressure [MAP]) and visit-to-visit variability in patients with type 2 diabetes.	Longitudinal cohort/ 2161 participants/ DM2	Oscillometric	HEM-1000, Omron Healthcare^®^* * Validation status not reported;	Long-term (visit-to-visit/two years ^ Number of measurements not informed.
Takao T (2014)(⁴⁵45 Takao T, Matsuyama Y, Yanagisawa H, Kikuchi M, Kawazu S. Visit-to-visit variability in systolic blood pressure predicts development and progression of diabetic nephropathy, but not retinopathy, in patients with type 2 diabetes. J Diabetes Complications. 2014;28(2):185-90. https://doi.org/10.1016/j.jdiacomp.2013.11.003 https://doi.org/10.1016/j.jdiacomp.2013.... ) Japan	To investigate whether visit-to-visit variability in systolic blood pressure (SBP) can predict the development and progression of diabetic nephropathy and retinopathy in patients with DM2.	Retrospective cohort/ 664 participants/ DM2	Oscillometric	BP-10, Omron Healthcare^®	Long-term (visit-to-visit/sixteen years ^ Number of measurements not informed.

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[1] Corresponding author: Antonia Fabiana Rodrigues da Silva E-mail: Fabi_enfer@hotmail.com