Blood Pressure Trajectories Prior to Death in Patients With Diabetes

• Published in: Diabetes care Vol. 34; no. 7; pp. 1534 - 1539
• Main Authors: Rogers, Mary A.M, Ward, Kathleen, Gure, Tanya R, Choe, Hae M, Lee, Pearl G, Bernstein, Steven J, Blaum, Caroline S
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.07.2011
• Subjects: adults; Aged; Ambulatory care; Beneficiaries; Biological and medical sciences; Blood pressure; Blood Pressure - physiology; Care and treatment; Clinical medicine; Comorbidity; Data collection; death; Diabetes; Diabetes Mellitus - mortality; Diabetes Mellitus - physiopathology; Diabetes. Impaired glucose tolerance; Diabetics; Diastole; Disease; Drug therapy; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Humans; Hypertension; linear models; Liver diseases; Longitudinal Studies; Male; Medicaid; Medical research; Medical sciences; Medicare; Medicine; Medicine, Experimental; Metabolic diseases; Middle Aged; Miscellaneous; mortality; Nutrition research; Older people; Original Research; patients; Practice; Public health. Hygiene; Public health. Hygiene-occupational medicine; Registries; Studies; Systole; United States - epidemiology; Writing; United States; Michigan; Endocrinopathy; Human; Nutrition; Diabetes mellitus; Mortality; Patient; Metabolic diseases; Epidemiology; Death; Arterial pressure; Blood pressure; Hemodynamics; Endocrinology
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/dc11-0441

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.