Blood pressure variability is associated with heart failure risk, elevated NT-proBNP, and elevated high-sensitivity troponin: the Multi-Ethnic Study of Atherosclerosis

BACKGROUND: It is not well established whether blood pressure variability (BPV) is associated with risk of incident heart failure (HF) as well as with subclinical markers of HF and myocardial injury. We investigated these relationships in the Multi-Ethnic Study of Atherosclerosis (MESA). METHODS: We examined the association between visit-to-visit BPV (estimated by variability independent of the mean-VIM) and HF in MESA (2000-2012), a community-based cohort study of 6814 individuals free of clinical cardiovascular disease (including HF) at baseline, using Cox models and joint longitudinal-survival models. VIM was calculated from Exams 1 to 5. Serial measurements (Exams 1 and 5) of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin-T (hs-cTnT) were used to test the early onset and directionality of the relationships by logistic regression. RESULTS: Over a median of 9.4 years of follow-up, VIM-SBP was associated with HF in adjusted Cox models including CVD risk factors (HR = 1.33 [95% CI, 1.03-1.69]), as well as in joint longitudinal-survival models. BPV was associated with elevated Exam 5 NT-proBNP (>125 pg/mL) after multivariable adjustment (VIM-SBP: OR = 1.26 [95% CI, 1.17-1.37]; VIM-DBP: OR = 1.23 [95% CI, 1.14-1.33]) and Exam 5 elevation in hs-cTnT (for VIM-SBP, OR = 1.27). CONCLUSIONS: BPV was associated with incident HF and longitudinal increases of subclinical markers of HF and myocardial injury in a multi-ethnic community-based cohort. These data indicate that visit-to-visit BPV may contribute to the development of HF.