Systolic blood pressure variability as a risk factor for stroke and cardiovascular mortality in the elderly hypertensive population

Abstract

, on behalf of the Syst-Eur investigatorsObjective To investigate whether baseline systolic blood pressure variability was a risk factor for stroke, cardiovascular mortality or cardiac events during the SystEur trial.Design The Syst-Eur study was a randomized, doubleblind, placebo-controlled trial, powered to detect differences in stroke rate between participants on active antihypertensive treatment and placebo. Systolic blood pressure variability measurements were made on 744 participants at the start of the trial. Systolic blood pressure variability was calculated over three time frames: 24 h, daytime and night-time. The placebo and active treatment subgroups were analysed separately using an intention-totreat principle, adjusting for confounding factors using a multiple Cox regression model. Participants An elderly hypertensive European population.Main outcome measures Stroke, cardiac events (fatal and non-fatal heart failure, fatal and non-fatal myocardial infarction and sudden death) and cardiovascular mortality (death attributed to stroke, heart failure, myocardial infarction, sudden death, pulmonary embolus, peripheral vascular disease and aortic dissection).Results The risk of stroke increased by 80% (95% confidence interval: 17-176%) for every 5 mmHg increase in night-time systolic blood pressure variability in the placebo group. Risk of cardiovascular mortality and cardiac events was not significantly altered. Daytime variability readings did not predict outcome. Antihypertensive treatment did not affect systolic blood pressure variability over the median 4.4-year follow-up. ConclusionIn the placebo group, but not the active treatment group, increased night-time systolic blood pressure variability on admission to the Syst-Eur trial was an independent risk factor for stroke during the trial.

Short-term variability and nocturnal decline in ambulatory blood pressure in normotension, white-coat hypertension, masked hypertension and sustained hypertension: a population-based study of older individuals in Spain

“…6 Most studies have found that high 24-hour BP variability is associated with organ damage and may contribute to cardiovascular risk prediction, over and beyond mean BP. [7][8][9][10][11][12][13][14][15][16][17] However, the degree to which variability improves the prediction of cardiovascular risk is controversial. [18][19][20] Previous studies have shown that nighttime BP is generally a better predictor of cardiovascular outcomes than daytime BP in patients with hypertension, and diminished nocturnal decline in BP is associated with or predictive of organ damage and cardiovascular events.…”

Simvastatin prevents large blood pressure variability induced aggravation of cardiac hypertrophy in hypertensive rats by inhibiting RhoA/Ras–ERK pathways

“…[7][8][9] Further, large BP variability is an independent risk factor for cardiovascular events in hypertensive patients. [10][11][12] However, the mechanism by which hypertensive cardiac remodeling is aggravated by increased BP variability remains unknown. Recently, we have created a rat model exhibiting a combination of hypertension and large BP variability by performing bilateral sinoaortic denervation (SAD) in spontaneously hypertensive rats (SHRs).…”

Temporal changes in the control of blood pressure in an older Australian population

“…2 Furthermore, elevated systolic blood pressure (SBP) is associated with greater risk than elevated diastolic blood pressure (DBP) in older persons. 2,[7][8][9] In the last decade, a number of clinical trials have consistently shown that successful antihypertensive therapy significantly decreased rates of cerebrovascular and cardiovascular morbidity and mortality in the elderly. 3,4,[9][10][11] Hypertension is the most common primary diagnosis from 35 million doctor visits in the United States.…”