Mean arterial pressure and pulse pressure in relation to cardiovascular disease risk among individuals with diabetes

Abstract

Cardiovascular disease (CVD) risk is elevated in diabetes, but the contributions of mean arterial pressure (MAP), pulse pressure (PP), and their long-term variability remain unclear. We analyzed 1,065 individuals with diabetes from the nationally representative CHARLS cohort (2011–2020). PP and MAP, plus BP variability metrics, were evaluated for incident CVD using logistic and Cox models, with subgroup, spline, and sensitivity analyses. BP variability was assessed using repeated measurements of PP and MAP in 2011, 2013, and 2015, with within-participant indices including mean, standard deviation (SD), coefficient of variation (CV), average real variability (ARV), root mean square of successive differences (RMSSD), range, variance (PV), and variability independent of the mean (VIM). Over a median 9-year follow-up, 256 (24.0%) participants developed CVD. Baseline MAP was consistently associated with CVD risk (per SD: hazard ratio [HR] 1.28, 95% CI: 1.08–1.52). PP-CVD associations weakened after adjustment. BP variability analyses showed no significant associations for MAP variability, whereas higher PP SD, ARV, RMSSD, range, and variance were associated with 18–25% higher CVD risk in fully adjusted models. Elevated MAP was consistently associated with CVD risk in individuals with diabetes, while PP variability offered additional prognostic information. Integrated monitoring of MAP levels and PP variability may help refine vascular risk stratification, pending external validation. Not applicable.