Key result
Higher visit-to-visit SBP variability is linked to incrementally higher mortality, CHD, stroke, and ESRD risks.
Why the study?
Previous studies linked visit-to-visit systolic blood pressure variability to adverse outcomes, but were limited by small sample sizes, selected populations, and restricted outcomes.
Does higher systolic blood pressure variability increase the risk of mortality, coronary heart disease, stroke, and end-stage renal disease in U.S. veterans?
Population
2,865,157 U.S. veterans with normal eGFR and ≥8 outpatient BP measurements
Comparison
Quartiles of systolic blood pressure variability (SD 10.3-12.7, 12.7-15.6, and ≥15.6 vs <10.3 mm Hg)
Design
Cohort study
Authors
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Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“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.”
“Patients with larger fluctuations in blood pressure are at higher risk to die or develop cardiovascular disease, or kidney failure. It is important to pay attention not only to 'static' blood pressure values, but also to evaluate whether the same individual has significant swings in blood pressure from low to high values (or vice versa) measured on different occasions.”
May inform risk stratification among veterans; hypothesis-generating for BP variability as a modifiable target.
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.
Gosmanova et al. (2016) 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.
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