Key result
Higher within-visit variability of systolic blood pressure was not significantly associated with all-cause mortality (HR 1.13; 95% CI 0.95-1.33 for highest vs lowest quintile; P=0.136).
Why the study?
Does within-visit variability of blood pressure predict all-cause and cardiovascular mortality in US adults?
Cohort (n=15,317)
Yes
Does within-visit variability of blood pressure predict all-cause and cardiovascular mortality in US adults?
Within-visit variability of blood pressure during a single medical evaluation does not predict long-term all-cause or cardiovascular mortality.
Answers are grounded in this paper and cite their sources.
Within-visit BP variability may signal higher mortality risk; leaves open its added value for risk stratification beyond mean BP.
The association between within-visit variability of systolic blood pressure (SBP) and diastolic blood pressure (DBP) and all-cause and cardiovascular (CVD) mortality was examined using the Third National Health and Nutrition Survey (n=15,317). Three SBP and DBP readings were taken by physicians during a single medical evaluation. Within-visit variability for each participant was defined using the standard deviation of SBP and DBP across these measurements. Mortality was assessed over 14 years (n=3848 and n=1684 deaths from all causes and CVD, respectively). After age, sex, and race-ethnicity adjustment, the hazard ratios (95% confidence intervals) for all-cause mortality associated with the 4 highest quintiles of within-visit standard deviation of SBP (2.00-2.99 mm Hg, 3.00-3.99 mm Hg, 4.00-5.29 mm Hg, and ≥5.30 mm Hg) compared with participants in the lowest quintile of within-visit standard deviation of SBP (<2.0 mm Hg) were 1.04 (0.87-1.26), 1.09 (0.92-1.29), 1.06 (0.88-1.28), and 1.13 (0.95-1.33), respectively (P=.136). The analogous hazard ratios for CVD mortality were 0.95 (0.69-1.32), 0.96 (0.67-1.36), 0.95 (0.74-1.23), and 1.04 (0.80-1.35), respectively (P=.566). No association with mortality was present after further adjustment and when modeling within-visit standard deviation of SBP as a continuous variable. Standard deviation of DBP was not associated with mortality.
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Muntner et al. (2012) conducted a cohort in General population (n=15,317). Higher within-visit variability of systolic blood pressure vs. Lowest quintile of within-visit standard deviation of SBP (<2.0 mm Hg) was evaluated on All-cause mortality (HR 1.13, 95% CI 0.95-1.33, p=0.136). Higher within-visit variability of systolic blood pressure was not significantly associated with all-cause mortality (HR 1.13; 95% CI 0.95-1.33 for highest vs lowest quintile; P=0.136).
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