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Visit-to-visit blood pressure variability and hip fracture risk in older persons

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Abstract

Summary

We investigated the association between blood pressure variability measured by the coefficient of variation (CV) of blood pressure and hip fracture in older persons with diabetes. After excluding patients with acute complications and comorbidities, a positive association with similar magnitude of strength was found between BP variability and hip fracture, compared with that in the original analysis.

Introduction

Hypertension is a risk factor of osteoporosis and hip fracture, but studies have yet to investigate whether blood pressure variability measured by the CV of blood pressure can predict hip fracture in older persons with diabetes.

Methods

We conducted a retrospective cohort study on 21,160 patients who suffered from type 2 diabetes (age ≥ 50 years) and participated in the National Diabetes Care Management Program in Taiwan. The patients’ 1-year variability in systolic blood pressure (SBP) and diastolic blood pressure (DBP) at the baseline and subsequent hip fracture incidence for 8.2 years were analyzed.

Results

There were 937 recorded incident hip fractures. SBP-CV and DBP-CV were classified based on their tertiles. After multivariate adjustment was conducted, SBP-CV found to be a predictor of hip fracture, and its hazard ratio was 1.18 (95% CI 1.00–1.40) for the third tertile compared with the first tertile.

Conclusions

Our study suggests SBP stability is a predictor for hip fracture incidence in older persons with type 2 diabetes.

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Abbreviations

DM:

diabetes mellitus

FPG:

fasting plasma glucose

BP:

blood pressure

NDCMP:

National Diabetes Care Management Program

NHI:

National Health Insurance

PIN:

personal identification number

CAD:

coronary artery disease

CVs:

coefficients of variability

SBP:

systolic blood pressure

DBP:

diastolic blood pressure

HRs:

hazard ratios

CIs:

confidence intervals

OAD:

oral glucose-lowering drug

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Acknowledgements

This study was supported primarily by the Bureau of National Health Insurance (DOH94-NH-1007); the Ministry of Science and Technology of Taiwan (NSC 101-2314-B-039-017-MY3 & NSC 102-2314-B-039-005-MY2 & MOST 104-2314-B-039-016, MOST 105-2314-B-039-021-MY3 & MOST 105-2314-B-039-025-MY3); the Ministry of Health and Welfare, Taiwan (MOHW107-TDU-B-212-123004); and China Medical University Hospital (DMR-107-119).

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Correspondence to C.-C. Lin.

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This study was approved by the Ethical Review Board of China Medical University Hospital (CMUH102-REC3-016).

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Li, TC., Li, CI., Liu, CS. et al. Visit-to-visit blood pressure variability and hip fracture risk in older persons. Osteoporos Int 30, 763–770 (2019). https://doi.org/10.1007/s00198-019-04899-7

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