Retrospective cohort study of the relationship between systolic blood pressure variability and multiple sclerosis disability

Abstract

ObjectiveTo examine the relationship between visit-to-visit systolic blood pressure (SBP) variability and patient-reported outcome measure of disability in multiple sclerosis (MS) patients.DesignA retrospective cohort study of individuals with MS who completed a patient-determined disease steps (PDDS) scale between 2011 and 2015 at an MS specialty clinic.ParticipantsIndividuals with MS for whom both a completed PDDS scale and ≥3 SBP measures within the prior 12 months of the survey were available.Main outcome measureParticipants were grouped into three classes of disability (no or mild (PDDS 0–1), moderate (2–3), severe (4–7)). SBP variability was calculated as within-subject SD using all SBP measures taken during the past 12 months. SBP variability was analysed by Tertile groups.ResultsNinety-two subjects were included in this analysis. Mean PDDS score was 2.22±1.89. Compared with subjects in Tertile 1 (lowest variability), the odds of being in a higher disability group was 3.5 times higher (OR=3.48; 95% CI: 1.08 to 11.25; p=0.037) in Tertile 2 and 5.2 times higher (OR=5.19; 95% CI: 1.53 to 17.61; p=0.008) in Tertile 3 (highest variability), independent of mean SBP, age, sex, race/ethnicity, body mass index and comorbidities (p for trend=0.008). Mean PDDS scores were 1.52±1.18 in Tertile 1, 2.73±1.02 in Tertile 2 and 2.42±0.89 in Tertile 3 after adjusting for the same covariates.ConclusionsOur results show a significant gradient relationship between SBP variability and MS-related disability. More research is needed to determine the underlying pathophysiological relationship between SBP variability and MS disability progression.

Hypertension and hypertension severity in Hispanics/Latinx with MS

“…Several VCs have previously been associated with MS disability in predominantly White cohorts including HTN, BP variability, DM, HLD, and peripheral vascular disease. 5,6,8 In contrast to the previous White cohorts which found associations with multiple VC, only HTN was independently associated with disability in our cohort, indicating that the relationship between VC and disability is mostly driven by HTN in this population. This association increased with increasing stages of HTN, which underscores the importance of BP staging using the AHA definition in future studies.…”

“…4,5 Hypertension (HTN) in particular is associated with increased hospitalizations, disability progression, and brain atrophy. 2,5,6 Contemporary studies suggest VC, such as HTN, to be common, ranging between 6.9% and 22.8%. 1,5,[7][8][9] Nevertheless, there are substantial gaps in our understanding of comorbidity in racial and ethnic minority groups with MS such as Latinx.…”

The road to conception for women with multiple sclerosis

“… 2 , 24 , 25 As done by others, (e.g. see 24 , 26 ) PDDS scores were classified into 3 distinctive disability groups as follows: no or mild (PDDS 0-1), moderate (PDDS 2-3) and severe (PDDS 4 or higher).…”

Progressive Multiple Sclerosis

“…79 Recently, patients with MS with systolic blood pressure variability and greater blood pressure severity (stage II as staged by the American Heart Association) were found to have greater risk of MS-related disability. 80,81 More research is needed to determine the pathways in which having MS and vascular comorbidity interact. Beyond the current work focused on vascular comorbidities, additional studies around the impact of other comorbidities (eg, psychiatric comorbidities) and their impact on MS progression are needed.…”