Blood Pressure Trajectories Prior to Death in Patients With Diabetes
- Mary A.M. Rogers, PHD1⇓,
- Kathleen Ward, MPA2,
- Tanya R. Gure, MD1,
- Hae M. Choe, PHARMD3,
- Pearl G. Lee, MD, MS1,4,
- Steven J. Bernstein, MD, MPH1,2,5 and
- Caroline S. Blaum, MD, MS1,4
- 1Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
- 2Quality Management Program, University of Michigan Health System, Ann Arbor, Michigan
- 3Department of Clinical, Social, and Administrative Sciences, University of Michigan College of Pharmacy, Ann Arbor, Michigan
- 4Geriatric Research, Education and Clinical Center, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan
- 5Health Services Research and Development Service Center for Clinical Management Research and Diabetes Quality Enhancement Research Initiative (QUERI), Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan
- Corresponding author: Mary A.M. Rogers, .
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.
- Received March 4, 2011.
- Accepted April 8, 2011.
- © 2011 by the American Diabetes Association.
Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.