Blood Pressure Variability and the Risk of All-Cause Mortality, Incident Myocardial Infarction, and Incident Stroke in the Cardiovascular Health Study

Suchy‐Dicey, Astrid; Wallace, Erin; Mitchell, Siobhán; Aguilar, Maria M; Gottesman, Rebecca F.; Rice, Kenneth; Kronmal, Richard A.; Psaty, Bruce M.; Longstreth, W. T.

doi:10.1093/ajh/hpt092

Cited by 88 publications

(73 citation statements)

References 27 publications

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“…An association also tended to be present for average real variability and peak value, two alternative measures of SBP variability. These data add to the evidence that SBP variability is a risk factor for renal outcomes as well as CVD (25), dementia (26,27), and all-cause mortality (28).…”

Section: Discussionmentioning

confidence: 51%

Visit-to-Visit Variability of BP and CKD Outcomes

Whittle

Lynch²,

Tanner³

et al. 2016

Clinical Journal of the American Society of Nephrology

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Background and objectives Increased visit-to-visit variability of BP is associated with cardiovascular disease risk. We examined the association of visit-to-visit variability of BP with renal outcomes among 21,245 participants in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial.Design, setting, participants, & measurements We measured mean BP and visit-to-visit variability of BP, defined as SD, across five to seven visits occurring 6-28 months after participants were randomized to chlorthalidone, amlodipine, or lisinopril. The composite outcome included incident ESRD after assessment of SD of systolic BP or $50% decline in eGFR between 24 months and 48 or 72 months after randomization. We repeated the analyses using average real variability and peak value of systolic BP and for visit-to-visit variability of diastolic BP.Results Over a mean follow-up of 3.5 years, 297 outcomes occurred. After multivariable adjustment, including baseline eGFR and mean systolic BP, the hazard ratios for the composite end point were 1.29 (95% confidence interval [95% CI], 0.75 to 2.22), 1.76 (95% CI, 1.06 to 2.91), 1.46 (95% CI, 0.88 to 2.45), and 2.05 (95% CI, 1.25 to 3.36) for the second through fifth (SD of systolic BP =6. 63-8.82, 8.83-11.14, 11.15-14.56, and .14.56 mmHg, respectively) versus the first (SD of systolic BP ,6.63 mmHg) quintile of SD of systolic BP, respectively (P trend =0.004). The association was similar when ESRD and a 50% decline in eGFR were analyzed separately, for other measures of visit-to-visit variability of systolic BP, and for visit-to-visit variability of diastolic BP. ConclusionsHigher visit-to-visit variability of BP is associated with higher risk of renal outcomes independent of mean BP.

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Section: Discussionmentioning

confidence: 51%

Visit-to-Visit Variability of BP and CKD Outcomes

Whittle

Lynch²,

Tanner³

et al. 2016

Clinical Journal of the American Society of Nephrology

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“…These results were confirmed in type 2 diabetes, 7 in chronic kidney disease 8 and in elderly. 9 However, the relationship was not found in other populations of treated hypertensive patients given lacidipine or atenolol, 10 nor in a general primary care US population where the impact was not statistically significant in normotensive subjects. 11 In 2944 individuals from Belgium general population, SBP variability over 10 readings was not associated with 12-year total mortality or composite cardiovascular end-point excepting for the latter in a subset of the sample: treated hypertensive individuals and women.…”

Section: Introductionmentioning

confidence: 95%

Individual 6-year systolic blood pressure change and impact on cardiovascular mortality in a French general population

Pannier¹,

Thomas²,

Hanon

et al. 2015

J Hum Hypertens

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Impact of blood pressure (BP) visit-to-visit variability remains controversial for untreated hypertensives and for normotensive subjects. Association between 6-year systolic BP change and all-cause and cardiovascular (CVD) mortality was studied in general primary care population including untreated hypertensive and normotensive subjects. Normotensive individuals and untreated high BP patients (40,926 and 14,283, respectively) had two check-ups (interval: 5.8±2.2 years) at the IPC center (Paris). Follow-up was 6.1±3.2 years: 1131 people died, 114 from CVD causes. Systolic BP (SBP) change was assessed by tertiles of absolute differences between V1 and V2, and the relationship with mortality was analysed with multivariate Cox models (hazard ratio (HR), 95% confidence interval (CI)) including V1 or V2 parameters notably SBP. Adjusting for V1 variables, mortality was associated with SBP change, for the entire population (all-cause: HR=1.15 (95%: 1.01-1.30) and CVD: HR=1.95 (95%: 1.25-3.05)) and in hypertensive individuals: (HR=1.31 (95%: 1.08-1.59) and HR=2.51 (95%: 1.34-4.72), respectively). Adjustments for V2 variables gave similar results. For those who were normotensive at V1, the associations were not significant. In this primary care population, individual long-term visit-to-visit change of BP is an independent predictor of all-cause mortality in hypertensive individuals but not in those with normal BP.

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“…Suchy-Dicey et al 26 showed that SD BPV was predictive of all fatal and nonfatal cardiovascular outcomes aside from stroke.…”

Section: -25mentioning

confidence: 99%

Antihypertensive Drug Use, Blood Pressure Variability, and Incident Stroke Risk in Older Adults

Tully

Debette

Dartigues

et al. 2016

Stroke

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Background and Purpose-The aim was to determine the association between antihypertensive drug class and incident stroke controlling for long-term blood pressure (BP) variability (BPV) in people aged ≥65 years. Methods-The sample included 5951 participants (median age 74 years, 60% women) taking at least 1 drug for hypertension (3727/5951) or with systolic BP >140 mm Hg or diastolic BP >90 mm Hg. Participants were evaluated for incident fatal and nonfatal stroke to 12 years follow-up. BPV was calculated with the coefficient of variation method and regressed against 9 antihypertensive drug classes (BPV reg ). Hazard models were used to determine hazard ratios for incident stroke risk attributable to drug class, adjusted for BP, BPV reg , covariates, and delayed entry bias. Results-There were 273 incident strokes over a median of 9.1 years (interquartile range 6.4-10.4). Stroke risk was generally not reduced by BP-lowering drugs. Angiotensin receptor blockers (hazard ratio 1.56; 95% confidence interval 1.06-2.28; P=0.02) and β-blockers (hazard ratio 1.41; 95% confidence interval 1.03-1.92; P=0.03) were associated with an increased total stroke risk. Angiotensin receptor blockers and β-blockers were also associated with ischemic strokes after adjustment for systolic BPV. Diastolic BPV was associated with stroke risk in analyses stratified by systolic BP 140 to 160 mm Hg (per 0.10 increase in coefficient of variation, hazard ratio 1.59; 95% confidence interval 1.05-2.40; P=0.03). Conclusions-The angiotensin receptor blocker and β-blocker drug classes were associated with incident stroke and ischemic stroke in older adults. BPV was generally not associated with incident stroke. .).The online-only Data Supplement is available with this article at http://stroke.ahajournals.org/lookup/suppl

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Blood Pressure Variability and the Risk of All-Cause Mortality, Incident Myocardial Infarction, and Incident Stroke in the Cardiovascular Health Study

Abstract: Long-term visit-to-visit SBP variability was independently associated with a higher risk of subsequent mortality and MI but not stroke. More research is needed to determine the relationship of BP variability with cardiovascular risk and the clinical implications.

Cited by 88 publications

References 27 publications

Visit-to-Visit Variability of BP and CKD Outcomes

Visit-to-Visit Variability of BP and CKD Outcomes

Individual 6-year systolic blood pressure change and impact on cardiovascular mortality in a French general population

Antihypertensive Drug Use, Blood Pressure Variability, and Incident Stroke Risk in Older Adults

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