January 1, 2005Open Access

Impact of Blood Pressure Variability on Cardiovascular Events in Elderly Patients with Hypertension

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Hypertension (n=106). Intervention: High blood pressure variability (CV of 24-h SBP ≥10.6%) vs. Low blood pressure variability (CV of 24-h SBP <10.6%). Primary outcome: Cardiovascular events (HR 3.58, 95% CI 1.63-7.85, p=<0.05).

Key Result

Increased 24-hour systolic blood pressure variability was an independent predictor of cardiovascular events in elderly hypertensive patients (HR 3.58).

Study Design

Type

Cohort (n=106)

Multicenter

PICO

Population

106 elderly hypertensive patients aged 60 to 91 years who underwent 24-hour ambulatory blood pressure monitoring, followed for a median of 34 months.

Exposure / Comparator

High blood pressure variability (CV of 24-h SBP ≥10.6%) vs Low blood pressure variability (CV of 24-h SBP <10.6%)

Primary Outcome

Cardiovascular events — HR 3.58 (1.63-7.85), p=<0.05

Main Result

Hazard Ratio: 3.58 (95% CI 1.63–7.85)

p-value: p=<0.05

Limitations

Discontinuous method of measuring blood pressure (every 30 min) may reduce accuracy of variability estimates
Short-term reproducibility of parameters had correlation coefficients that were not high enough
Extreme dippers may have been misclassified as high CV patients
Antihypertensive drugs used by all patients may have confounded blood pressure variability and outcomes
Patients with and without baseline organ damage were analyzed together
Retrospective longitudinal design with only a single baseline 24-h blood pressure measurement

Abstract

Blood pressure variability is one of the characteristic features of hypertension in the elderly. However, its clinical significance remains to be determined. We therefore examined the impact of blood pressure variability on the development of cardiovascular events in elderly hypertensive patients. A total of 106 consecutive hypertensive patients aged more than 60 years old (mean age, 73.9 +/- 8.1 years old; male, 54%), all of whom underwent 24-h ambulatory blood pressure monitoring, were followed up (median, 34 months; range, 3-60 months). During the follow-up period, 39 cardiovascular events were observed, including 14 cases of cerebral infarction and 7 cases of acute myocardial infarction. The coefficient of variation (CV) of 24-h systolic blood pressure (SBP) values was used as an index of blood pressure variability. The patients showed a mean CV value of 10.6%, and were divided into two groups according to this mean value as a cut-off point: a high CV group (n = 46) and a low CV group (n = 60). Although baseline clinical characteristics were similar in the two groups, Kaplan-Meier plots for event-free survival revealed that the rate of cardiovascular events was significantly higher in high CV group than in low CV group (p < 0.05). Cox's proportional hazards analysis showed that increased blood pressure variability (a high CV value of 24-h SBP) was an independent predictive variable for cardiovascular events. The CV value of daytime SBP and the SD value of both 24-h SBP and daytime SBP also had positive correlations with the onset of cardiovascular events. These results suggest that increased blood pressure variability may be an independent risk factor for cardiovascular events in elderly hypertensive patients.

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