High short-term blood pressure variability predicts long-term cardiovascular mortality in untreated hypertensives but not in normotensives

Pai Feng Hsu, Hao Min Cheng, Cheng Hsueh Wu, Shih Hsien Sung, Shao Yuan Chuang, Edward Lakatta, Frank C P Yin, Pesus Chou, Chen Huan Chen

Research output: Contribution to journalArticle

Abstract

BACKGROUND The prognostic value of the short-term blood pressure variability (BPV) from the 24-hour ambulatory blood pressure monitoring (ABPM) remains controversial. The present study aimed to investigate the longterm prognostic value of a high BPV in normotensive and hypertensive subjects from a community-based population. METHODS A cohort of 624 normotensive and 633 untreated hypertensive Taiwanese participants (overall 669 men, aged 30-79 years) with baseline ABPM and 20-year all-cause and cardiovascular mortality data was drawn from a community-based survey. BPV was assessed by the readto-read average real variability of the 24-hour diastolic and systolic blood pressure (SBP) (ARVd and ARVs, respectively). RESULTS In Cox proportional hazards analysis, ARVd predicted cardiovascular mortality independently of office SBP (hazard ratios (HRs) and 95% confidence intervals (CIs) per 1 SD: 1.31 (1.10-1.55), respectively, bivariate analysis), 24-hour SBP (HR: 1.19, 95% CI: 1.00-1.43), and conventional risk factors (age, sex, smoking, total cholesterol, high-density lipoprotein cholesterol, and fasting blood glucose, HR: 1.40, 95% CI: 1.18-1.67). In subjects with hypertension, a high vs. low ARVd (median: 8.8 mm Hg) significantly predicted cardiovascular mortality (HR: 2.11, 95% CI: 1.23-3.62 and HR: 2.04, 95% CI: 1.19-3.51, respectively), when the conventional risk factors plus office SBP or 24-hour SBP were accounted for, respectively. Similar but less significant results were obtained with ARVs. A high ARVd or ARVs did not significantly predict cardiovascular mortality in the normotensive subjects. CONCLUSIONS A high short-term BPV is significantly predictive of long-term cardiovascular mortality in untreated hypertensive but not normotensive community-based subjects, independently of office or 24-hour SBP.

Original languageEnglish (US)
Pages (from-to)806-813
Number of pages8
JournalAmerican Journal of Hypertension
Volume29
Issue number7
DOIs
StatePublished - 2016
Externally publishedYes

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Blood Pressure
Mortality
Confidence Intervals
Ambulatory Blood Pressure Monitoring
Hypertension
HDL Cholesterol
Blood Glucose
Fasting
Smoking
Cholesterol

Keywords

  • Ambulatory blood pressure
  • Blood pressure variability
  • Cardiovascular mortality
  • Hypertension

ASJC Scopus subject areas

  • Internal Medicine

Cite this

High short-term blood pressure variability predicts long-term cardiovascular mortality in untreated hypertensives but not in normotensives. / Hsu, Pai Feng; Cheng, Hao Min; Wu, Cheng Hsueh; Sung, Shih Hsien; Chuang, Shao Yuan; Lakatta, Edward; Yin, Frank C P; Chou, Pesus; Chen, Chen Huan.

In: American Journal of Hypertension, Vol. 29, No. 7, 2016, p. 806-813.

Research output: Contribution to journalArticle

Hsu, Pai Feng ; Cheng, Hao Min ; Wu, Cheng Hsueh ; Sung, Shih Hsien ; Chuang, Shao Yuan ; Lakatta, Edward ; Yin, Frank C P ; Chou, Pesus ; Chen, Chen Huan. / High short-term blood pressure variability predicts long-term cardiovascular mortality in untreated hypertensives but not in normotensives. In: American Journal of Hypertension. 2016 ; Vol. 29, No. 7. pp. 806-813.
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abstract = "BACKGROUND The prognostic value of the short-term blood pressure variability (BPV) from the 24-hour ambulatory blood pressure monitoring (ABPM) remains controversial. The present study aimed to investigate the longterm prognostic value of a high BPV in normotensive and hypertensive subjects from a community-based population. METHODS A cohort of 624 normotensive and 633 untreated hypertensive Taiwanese participants (overall 669 men, aged 30-79 years) with baseline ABPM and 20-year all-cause and cardiovascular mortality data was drawn from a community-based survey. BPV was assessed by the readto-read average real variability of the 24-hour diastolic and systolic blood pressure (SBP) (ARVd and ARVs, respectively). RESULTS In Cox proportional hazards analysis, ARVd predicted cardiovascular mortality independently of office SBP (hazard ratios (HRs) and 95{\%} confidence intervals (CIs) per 1 SD: 1.31 (1.10-1.55), respectively, bivariate analysis), 24-hour SBP (HR: 1.19, 95{\%} CI: 1.00-1.43), and conventional risk factors (age, sex, smoking, total cholesterol, high-density lipoprotein cholesterol, and fasting blood glucose, HR: 1.40, 95{\%} CI: 1.18-1.67). In subjects with hypertension, a high vs. low ARVd (median: 8.8 mm Hg) significantly predicted cardiovascular mortality (HR: 2.11, 95{\%} CI: 1.23-3.62 and HR: 2.04, 95{\%} CI: 1.19-3.51, respectively), when the conventional risk factors plus office SBP or 24-hour SBP were accounted for, respectively. Similar but less significant results were obtained with ARVs. A high ARVd or ARVs did not significantly predict cardiovascular mortality in the normotensive subjects. CONCLUSIONS A high short-term BPV is significantly predictive of long-term cardiovascular mortality in untreated hypertensive but not normotensive community-based subjects, independently of office or 24-hour SBP.",
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author = "Hsu, {Pai Feng} and Cheng, {Hao Min} and Wu, {Cheng Hsueh} and Sung, {Shih Hsien} and Chuang, {Shao Yuan} and Edward Lakatta and Yin, {Frank C P} and Pesus Chou and Chen, {Chen Huan}",
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T1 - High short-term blood pressure variability predicts long-term cardiovascular mortality in untreated hypertensives but not in normotensives

AU - Hsu, Pai Feng

AU - Cheng, Hao Min

AU - Wu, Cheng Hsueh

AU - Sung, Shih Hsien

AU - Chuang, Shao Yuan

AU - Lakatta, Edward

AU - Yin, Frank C P

AU - Chou, Pesus

AU - Chen, Chen Huan

PY - 2016

Y1 - 2016

N2 - BACKGROUND The prognostic value of the short-term blood pressure variability (BPV) from the 24-hour ambulatory blood pressure monitoring (ABPM) remains controversial. The present study aimed to investigate the longterm prognostic value of a high BPV in normotensive and hypertensive subjects from a community-based population. METHODS A cohort of 624 normotensive and 633 untreated hypertensive Taiwanese participants (overall 669 men, aged 30-79 years) with baseline ABPM and 20-year all-cause and cardiovascular mortality data was drawn from a community-based survey. BPV was assessed by the readto-read average real variability of the 24-hour diastolic and systolic blood pressure (SBP) (ARVd and ARVs, respectively). RESULTS In Cox proportional hazards analysis, ARVd predicted cardiovascular mortality independently of office SBP (hazard ratios (HRs) and 95% confidence intervals (CIs) per 1 SD: 1.31 (1.10-1.55), respectively, bivariate analysis), 24-hour SBP (HR: 1.19, 95% CI: 1.00-1.43), and conventional risk factors (age, sex, smoking, total cholesterol, high-density lipoprotein cholesterol, and fasting blood glucose, HR: 1.40, 95% CI: 1.18-1.67). In subjects with hypertension, a high vs. low ARVd (median: 8.8 mm Hg) significantly predicted cardiovascular mortality (HR: 2.11, 95% CI: 1.23-3.62 and HR: 2.04, 95% CI: 1.19-3.51, respectively), when the conventional risk factors plus office SBP or 24-hour SBP were accounted for, respectively. Similar but less significant results were obtained with ARVs. A high ARVd or ARVs did not significantly predict cardiovascular mortality in the normotensive subjects. CONCLUSIONS A high short-term BPV is significantly predictive of long-term cardiovascular mortality in untreated hypertensive but not normotensive community-based subjects, independently of office or 24-hour SBP.

AB - BACKGROUND The prognostic value of the short-term blood pressure variability (BPV) from the 24-hour ambulatory blood pressure monitoring (ABPM) remains controversial. The present study aimed to investigate the longterm prognostic value of a high BPV in normotensive and hypertensive subjects from a community-based population. METHODS A cohort of 624 normotensive and 633 untreated hypertensive Taiwanese participants (overall 669 men, aged 30-79 years) with baseline ABPM and 20-year all-cause and cardiovascular mortality data was drawn from a community-based survey. BPV was assessed by the readto-read average real variability of the 24-hour diastolic and systolic blood pressure (SBP) (ARVd and ARVs, respectively). RESULTS In Cox proportional hazards analysis, ARVd predicted cardiovascular mortality independently of office SBP (hazard ratios (HRs) and 95% confidence intervals (CIs) per 1 SD: 1.31 (1.10-1.55), respectively, bivariate analysis), 24-hour SBP (HR: 1.19, 95% CI: 1.00-1.43), and conventional risk factors (age, sex, smoking, total cholesterol, high-density lipoprotein cholesterol, and fasting blood glucose, HR: 1.40, 95% CI: 1.18-1.67). In subjects with hypertension, a high vs. low ARVd (median: 8.8 mm Hg) significantly predicted cardiovascular mortality (HR: 2.11, 95% CI: 1.23-3.62 and HR: 2.04, 95% CI: 1.19-3.51, respectively), when the conventional risk factors plus office SBP or 24-hour SBP were accounted for, respectively. Similar but less significant results were obtained with ARVs. A high ARVd or ARVs did not significantly predict cardiovascular mortality in the normotensive subjects. CONCLUSIONS A high short-term BPV is significantly predictive of long-term cardiovascular mortality in untreated hypertensive but not normotensive community-based subjects, independently of office or 24-hour SBP.

KW - Ambulatory blood pressure

KW - Blood pressure variability

KW - Cardiovascular mortality

KW - Hypertension

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