Higher visit-to-visit systolic blood pressure variability was associated with incrementally higher risks of all-cause mortality, coronary heart disease, stroke, and end-stage renal disease.
Cohort (n=2,865,157)
Does higher systolic blood pressure variability increase the risk of mortality, coronary heart disease, stroke, and end-stage renal disease in U.S. veterans?
Higher visit-to-visit systolic blood pressure variability is associated with increased risks of mortality, cardiovascular events, and end-stage renal disease, independent of absolute blood pressure levels.
BACKGROUND Intraindividual blood pressure (BP) fluctuates dynamically over time. Previous studies suggested an adverse link between greater visit-to-visit variability (VVV) in systolic blood pressure (SBP) and various outcomes. However, these studies have significant limitations, such as a small size, inclusion of selected populations, and restricted outcomes. OBJECTIVES We investigated the association of increased VVV and all-cause mortality, cardiovascular events, and end-stage renal disease (ESRD) in a large cohort of U.S. veterans. METHODS From among 3,285,684 U.S. veterans with and without hypertension and normal estimated glomerular filtration rates (eGFR) during 2005 and 2006, we identified 2,865,157 patients who had 8 or more outpatient BP measurements. SBP variability (SBPV) was measured using the SD of all SBP values (normally distributed) in 1 individual. Associations of SD quartiles (<10.3, 10.3 to 12.7, 12.7 to 15.6, and ≥15.6 mm Hg) with all-cause mortality, incident coronary heart disease (CHD), stroke, and ESRD was examined using Cox models adjusted for sociodemographic characteristics, baseline eGFR, comorbidities, body mass index, SBP, diastolic BP, and antihypertensive medication use. RESULTS Several sociodemographic variables (older age, male sex, African-American race, divorced or widowed status) and clinical characteristics (lower baseline eGFR, higher SBP and DBP), and comorbidities (presence of diabetes, hypertension, cardiovascular disease, and lung disease) were all associated with higher intraindividual SBPV. The multivariable adjusted hazard ratios and 95% confidence intervals for SD quartiles 2 through 4 (compared to the first quartile) associated with all-cause mortality, CHD, stroke, and ESRD were incrementally higher. CONCLUSIONS Higher SBPV in individuals with and without hypertension was associated with increased risks of all-cause mortality, CHD, stroke, and ESRD. Further studies are needed to determine interventions that can lower SBPV and their impact on adverse health outcomes.
“The association with risk is strikingly strong and consistent. There was a very nice graded association, which was consistent for deaths, stroke, coronary heart events, and end-stage renal disease, even after adjusting for confounders. What we know about [variability] thus far is this type of association exists. There have been previous studies showing similar results, but ours was probably the largest. This is not an entirely a new phenomenon.”
Gosmanova et al. (Thu,) conducted a cohort in Hypertension and normal eGFR (n=2,865,157). Visit-to-visit variability in systolic blood pressure vs. Lowest quartile of systolic blood pressure variability (<10.3 mm Hg) was evaluated on All-cause mortality, incident coronary heart disease (CHD), stroke, and ESRD. Higher visit-to-visit systolic blood pressure variability was associated with incrementally higher risks of all-cause mortality, coronary heart disease, stroke, and end-stage renal disease.