Change in Blood Pressure Variability Among Treated Elderly Hypertensive Patients and Its Association With Mortality

Abstract

BackgroundInformation is scarce regarding effects of antihypertensive medication on blood pressure variability (BPV) and associated clinical outcomes. We examined whether antihypertensive treatment changes BPV over time and whether such change (decline or increase) has any association with long‐term mortality in an elderly hypertensive population.Methods and ResultsWe used data from a subset of participants in the Second Australian National Blood Pressure study (n=496) aged ≥65 years who had 24‐hour ambulatory blood pressure recordings at study entry (baseline) and then after a median of 2 years while on treatment (follow‐up). Weighted day‐night systolic BPV was calculated for both baseline and follow‐up as a weighted mean of daytime and nighttime blood pressure standard deviations. The annual rate of change in BPV over time was calculated from these BPV estimates. Furthermore, we classified both BPV estimates as high and low based on the baseline median BPV value and then classified BPV changes into stable: low BPV, stable: high BPV, decline: high to low, and increase: low to high. We observed an annual decline (mean±SD: −0.37±1.95; 95% CI, −0.54 to −0.19; P<0.001) in weighted day‐night systolic BPV between baseline and follow‐up. Having constant stable: high BPV was associated with an increase in all‐cause mortality (hazard ratio: 3.03; 95% CI, 1.67–5.52) and cardiovascular mortality (hazard ratio: 3.70; 95% CI, 1.62–8.47) in relation to the stable: low BPV group over a median 8.6 years after the follow‐up ambulatory blood pressure monitoring. Similarly, higher risk was observed in the decline: high to low group.ConclusionsOur results demonstrate that in elderly hypertensive patients, average BPV declined over 2 years of follow‐up after initiation of antihypertensive therapy, and having higher BPV (regardless of any change) was associated with increased long‐term mortality.

A U-shaped association between the LDL-cholesterol to HDL-cholesterol ratio and all-cause mortality in elderly hypertensive patients: a prospective cohort study

“…Therefore, further basic experiments are needed to fully elucidate the specific biological mechanism underlying this connection. Compared with the normal population, elderly hypertensive patients have higher mortality [28]. Therefore, it is more important to identify a valuable predictor of mortality in this population.…”

Pulse Wave Velocity and Blood Pressure Variability as Prognostic Indicators in Very Elderly Patients

“…High long-term or mid-term BP variabilities have both been associated with mortality. With respect to short-term BP variability, an increased 24 h weighted SD (the mean of daytime and nighttime SD, weighted for the time duration of each period) was found to be associated with 8-year mortality in older (>65 years) participants of the Second Australian National Blood Pressure Study [ 18 ]. However, no data are available in the very elderly population regarding short-term or 24 h BP variability.…”

“…Other studies have found a correlation between arterial stiffness and mortality in old patients (usually older than 65 years) [ 12 , 13 ] or in those with heart failure with preserved ejection fraction (mean age 75) [ 14 ]. The prognostic impact of BP variability is also controversial in such populations [ 15 , 16 , 17 , 18 , 19 ].…”

Single‐pill combination of cilnidipine, an l‐/n‐type calcium channel blocker, and valsartan reduces the day‐by‐day variability of morning home systolic blood pressure in patients with treated hypertension: A sub‐analysis of the HOPE‐combi survey

“…21 The home BP variability is a risk factor for the development of cardiovascular events, independent of the average home BP, [22][23][24] and is associated with renal function. 25 In elderly hypertensive patients, the BP variability is also reported as a risk factor for mortality 26,27 and cardiovascular death 28 and a predictor of arterial stiffness progression. 29 Our conclusion that the SPC of Cil/Val reduces age-related increased home BP variability may have clinical significance.…”