Variability independent of mean blood pressure as a real-world measure of cardiovascular risk

Ebinger, Joseph; Driver, Matthew; Ouyang, David; Botting, Patrick; Ji, Hongwei; Rashid, Mohamad; Blyler, Ciantel A.; Bello, Natalie A.; Rader, Florian; Niiranen, Teemu J.; Albert, Christine M.; Cheng, Susan

doi:10.1016/j.eclinm.2022.101442

Cited by 13 publications

(5 citation statements)

References 36 publications

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“…SBP strongly predicts cardiovascular events, especially its variability over time. [ 28 ] Most physicians evaluate SPB regarding elevation above 140 mm Hg, which is undoubtedly associated with stroke. However, there are more effective forms of use, considering that changes in SPB can occur below 140 mm Hg and still be associated with hemorrhagic stroke.…”

Section: Discussionmentioning

confidence: 99%

Risk factors associated with hemorrhagic cerebrovascular accident: A cross-sectional study in patients from a hospital in Peru

Rosales-Rimache,

Ramos-Martínez,

Soncco-Llulluy

et al. 2023

Medicine

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In Peru, cardiovascular accidents (CVA) cause around 15% of premature death, with an increase in CVA due to the prevalence of risk factors for CVA in the Peruvian population. Hemorrhagic CVA presents higher mortality compared to ischemic. This research aimed to identify the risk factors associated with hemorrhagic CVA. We carried out a retrospective cross-sectional study using the medical records of patients with a diagnosis of CVA treated at the Regional Hospital of Ica during the years 2018 and 2019. Independent variables included age, sex, type 2 diabetes, dyslipidemia, hypertension, smoking, obesity, and intracranial carotid artery calcification. To identify factors associated with an increased probability for hemorrhagic CVA compared to ischemic CVA, a generalized linear model with logit link and binomial family, obtaining the odds ratio (OR) and its 95% confidence interval (CI). we evaluated the data from 132 patients. Of them, 46 (34.85%) had hemorrhagic CVA. Only systolic blood pressure (OR: 1.04; 95% CI: 1.02–1.06) and hypertension (OR: 0.29; 95% CI: 0.10–0.89) were significantly associated with hemorrhagic CVA compared to ischemic CVA. Hypertension is associated with hemorrhagic CVA compared to ischemic CVA. These results are consistent with the literature.

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Section: Discussionmentioning

confidence: 99%

Risk factors associated with hemorrhagic cerebrovascular accident: A cross-sectional study in patients from a hospital in Peru

Rosales-Rimache,

Ramos-Martínez,

Soncco-Llulluy

et al. 2023

Medicine

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“…The standard deviation of SBP and DBP amplitude measurements ( Figure 3A ) was obtained across the waveform’s duration as shown in Figure 3B and 3C . BP SD was then further processed into CV and VIM ( 3 ). Similar processes were repeated for diastolic BP metrics.…”

Section: Methodsmentioning

confidence: 99%

Reliability of beat-to-beat blood pressure variability in older adults

Lohman,

Sible,

Shenasa

et al. 2024

Preprint

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Blood pressure variability (BPV) is emerging as an important risk factor across numerous disease states, including cerebrovascular and neurodegenerative disease in older adults. However, there is no current consensus regarding specific use cases for the numerous available BPV metrics. There is also little published data supporting the ability to reliably measure BPV across metrics in older adults. BPV metrics were derived from continuous beat-to-beat blood pressure monitoring data. Two sequential 7-minute waveforms were analyzed. Absolute and relative reliability testing was performed. Differences between antihypertensive medication users and non-users on BPV metric reliability was also assessed. All sequence and dispersion based BPV metrics displayed good test-retest reliability. A measure of BP instability displayed only moderate reliability. Systolic and diastolic average real variability displayed the highest levels of reliability at ICC= .87 and .82 respectively. Additionally, systolic average real variability was the most reliable metric in both the antihypertensive use group, and the no antihypertensive use group. Beat-to-beat dispersion and sequence-based metrics of BPV can be reliably obtained from older adults using noninvasive continuous blood pressure monitoring. Average real variability may be the most reliable and specific beat-to-beat blood pressure variability metric due to its decreased susceptibility to outliers and low frequency blood pressure oscillations.

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“…Systolic and diastolic VIM were calculated separately. As previously described 56 , VIM is calculated first as the standard deviation of BP readings divided by the mean BP raised to the power of x , where x is obtained from fitting a nonlinear regression model among the entire sample where standard deviation = a* mean x . This quantity is then multiplied by the sample mean BP raised to the power of x .…”

Section: Methodsmentioning

confidence: 99%

Blood pressure variability supersedes heart rate variability as a real-world measure of dementia risk

Ebinger,

Driver,

Huang

et al. 2024

Sci Rep

Self Cite

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Blood pressure variability (BPV) and heart rate variability (HRV) have been associated with Alzheimer’s Disease and Related Dementias (ADRD) in rigorously controlled studies. However, the extent to which BPV and HRV may offer predictive information in real-world, routine clinical care is unclear. In a retrospective cohort study of 48,204 adults (age 54.9 ± 17.5 years, 60% female) receiving continuous care at a single center, we derived BPV and HRV from routinely collected clinical data. We use multivariable Cox models to evaluate the association of BPV and HRV, separately and in combination, with incident ADRD. Over a median 3 [2.4, 3.0] years, there were 443 cases of new-onset ADRD. We found that clinically derived measures of BPV, but not HRV, were consistently associated with incident ADRD. In combined analyses, only patients in both the highest quartile of BPV and lowest quartile of HRV had increased ADRD risk (HR 2.34, 95% CI 1.44–3.81). These results indicate that clinically derived BPV, rather than HRV, offers a consistent and readily available metric for ADRD risk assessment in a real-world patient care setting. Thus, implementation of BPV as a widely accessible tool could allow clinical providers to efficiently identify patients most likely to benefit from comprehensive ADRD screening.

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Variability independent of mean blood pressure as a real-world measure of cardiovascular risk

Cited by 13 publications

References 36 publications

Risk factors associated with hemorrhagic cerebrovascular accident: A cross-sectional study in patients from a hospital in Peru

Risk factors associated with hemorrhagic cerebrovascular accident: A cross-sectional study in patients from a hospital in Peru

Reliability of beat-to-beat blood pressure variability in older adults

Blood pressure variability supersedes heart rate variability as a real-world measure of dementia risk

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