TY - JOUR
T1 - Blood pressure variability and the risk of all-cause mortality, incident myocardial infarction, and incident stroke in the cardiovascular health study
AU - Suchy-Dicey, Astrid M.
AU - Wallace, Erin R.
AU - Mitchell, S. V.Elkind
AU - Aguilar, Maria
AU - Gottesman, Rebecca F.
AU - Rice, Kenneth
AU - Kronmal, Richard
AU - Psaty, Bruce M.
AU - Longstreth, W. T.
N1 - Funding Information:
B.M.P. serves on the Data Safety Monitoring Board for a clinical trial of a device funded by the manufacturer (2011 LifeCor) and serves on the steering committee of the Yale Open Data Access Project funded by Medtronic. All other authors declared no conflict of interest.
Funding Information:
A.M.S.-D. and E.R.W. contributed equally to this study in conception, development, analysis, and writing. They are supported by the NHLBI Cardiovascular Disease Training Grant, NIH I-T32-HL07902. The manuscript and all related analyses were developed with support from the CHS Neurology working group. The research reported in this article was supported by contracts HHSN268201200036C, N01-HC-85239, N01-HC-85079 through N01-HC-85086, N01-HC-35129, N01 HC-15103, N01 HC-55222, N01-HC-75150, N01-HC-45133, and grant HL080295 from the National Heart, Lung, and Blood Institute (NHLBI), with additional contribution from the National Institute of Neurological Disorders and Stroke (NINDS). Additional support was provided through AG-023629, AG-15928, AG-20098, and AG-027058 from the National Institute on Aging (NIA). A full list of principal CHS investigators and institutions can be found at http://www. chs-nhlbi.org/pi.htm.
PY - 2013/10
Y1 - 2013/10
N2 - BACKGROUNDRecent reports have linked variability in visit-to-visit systolic blood pressure (SBP) to risk of mortality and stroke, independent of the effect of mean SBP level. This study aimed to evaluate whether variability in SBP is associated with all-cause mortality, incident myocardial infarction (MI), and incident stroke, independent of mean SBP or trends in SBP levels over time.METHODSThe Cardiovascular Health Study is a longitudinal cohort study of vascular risk factors and disease in the elderly. Participants who attended their first 5 annual clinic visits and experienced no event before the 5th visit were eligible (n = 3,852). Primary analyses were restricted to participants not using antihypertensive medications throughout the first 5 clinic visits (n = 1,642). Intraindividual SBP variables were defined using each participant's 5-visit blood pressure measures. Cox proportional hazards models estimated adjusted hazard ratios (HRs) per SD increase in intraindividual SBP variability, adjusted for intraindividual SBP mean and change over time.RESULTSOver a mean follow-up of 9.9 years, there were 844 deaths, 203 MIs, and 195 strokes. Intraindividual SBP variability was significantly associated with increased risk of mortality (HR = 1.13; 95% confidence interval (CI) = 1.05-1.21) and of incident MI (HR = 1.20; 95%CI = 1.06-1.36), independent of the effect from adjustment factors. Intraindividual SBP variability was not associated with risk of stroke (HR = 1.03; 95% CI = 0.89-1.21).CONCLUSIONSLong-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.
AB - BACKGROUNDRecent reports have linked variability in visit-to-visit systolic blood pressure (SBP) to risk of mortality and stroke, independent of the effect of mean SBP level. This study aimed to evaluate whether variability in SBP is associated with all-cause mortality, incident myocardial infarction (MI), and incident stroke, independent of mean SBP or trends in SBP levels over time.METHODSThe Cardiovascular Health Study is a longitudinal cohort study of vascular risk factors and disease in the elderly. Participants who attended their first 5 annual clinic visits and experienced no event before the 5th visit were eligible (n = 3,852). Primary analyses were restricted to participants not using antihypertensive medications throughout the first 5 clinic visits (n = 1,642). Intraindividual SBP variables were defined using each participant's 5-visit blood pressure measures. Cox proportional hazards models estimated adjusted hazard ratios (HRs) per SD increase in intraindividual SBP variability, adjusted for intraindividual SBP mean and change over time.RESULTSOver a mean follow-up of 9.9 years, there were 844 deaths, 203 MIs, and 195 strokes. Intraindividual SBP variability was significantly associated with increased risk of mortality (HR = 1.13; 95% confidence interval (CI) = 1.05-1.21) and of incident MI (HR = 1.20; 95%CI = 1.06-1.36), independent of the effect from adjustment factors. Intraindividual SBP variability was not associated with risk of stroke (HR = 1.03; 95% CI = 0.89-1.21).CONCLUSIONSLong-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.
KW - blood pressure
KW - blood pressure variability
KW - hypertension
KW - mortality
KW - myocardial infarction
KW - stroke
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U2 - 10.1093/ajh/hpt092
DO - 10.1093/ajh/hpt092
M3 - Article
C2 - 23744496
AN - SCOPUS:84890104540
SN - 0895-7061
VL - 26
SP - 1210
EP - 1217
JO - American Journal of Hypertension
JF - American Journal of Hypertension
IS - 10
ER -