September 17, 2015
View Full PaperBlood pressure variability predicts cardiovascular events independently of traditional cardiovascular risk factors and target organ damage
Key Result
Higher in-treatment diastolic blood pressure variability independently predicted the composite of cardiovascular death, MI, or stroke (HR per 1 mmHg increase 1.04; 95% CI 1.01-1.06; P=0.005).
Study Design
Type
RCT (n=8,505)
Randomization
randomized
Structured PICO
Does high in-treatment visit-to-visit blood pressure variability predict cardiovascular events in hypertensive patients with left ventricular hypertrophy?
P
Population
8,505 hypertensive patients with left ventricular hypertrophy randomized to losartan vs. atenolol-based treatment.
I
Intervention
High in-treatment visit-to-visit blood pressure variability (assessed as SD and range for BP measured at 6, 12, 18 and 24 months)
C
Comparator
Lower blood pressure variability
O
Outcome
Composite endpoint of cardiovascular death, nonfatal myocardial infarction (MI) or stroke occurring after 24 monthscomposite
Higher in-treatment visit-to-visit blood pressure variability independently predicts cardiovascular events and stroke in hypertensive patients with left ventricular hypertrophy.
Main Result
Hazard Ratio: 1.04 (95% CI 1.01–1.06)
p-value: p=0.005
Abstract
BACKGROUND: Assessment of antihypertensive treatment is normally based on the mean value of a number of blood pressure (BP) measurements. However, it is uncertain whether high in-treatment visit-to-visit BP variability may be harmful in hypertensive patients with left ventricular hypertrophy (LVH). METHODS: In 8505 patients randomized to losartan vs. atenolol-based treatment in the LIFE study, we tested whether BP variability assessed as SD and range for BP6-24 months measured at 6, 12, 18 and 24 months of treatment was associated with target organ damage (TOD) defined by LVH on ECG and urine albumin/creatinine ratio at 24 months, and predicted the composite endpoint (CEP) of cardiovascular death, nonfatal myocardial infarction (MI) or stroke occurring after 24 months (CEP = 630 events). RESULTS: In multiple regression models adjusted for mean BP6-24 months and treatment allocation, neither high BP6-24 months SD nor wide range were related to TOD at 24 months, except for a weak association between Sokolow-Lyon voltage and DBP6-24 months SD and range (both β = 0.04, P < 0.01). Independently of mean BP6-24 months, treatment allocation, TOD and baseline characteristics in Cox regression models, CEP after 24 months was associated with DBP6-24 months SD hazard ratio per 1 mmHg increase1.04, 95% confidence interval (95% CI) 1.01-1.06, P = 0.005, range (hazard ratio 1.02, 95% CI 1.01-1.03, P = 0.004), SBP6-24 months SD (hazard ratio 1.01, 95% CI 0.99-1.02, P = 0.07) and range (hazard ratio 1.006, 95% CI 1.001-1.01, P = 0.04). Adjusted for the same factors, stroke was associated with DBP6-24 months SD (hazard ratio 1.06, 95% CI 1.02-1.10, P = 0.001), range (hazard ratio 1.03, 95% CI 1.01-1.04, P = 0.001), SBP6-24 months SD (hazard ratio 1.02, 95% CI 1.002-1.04, P = 0.04) and range (hazard ratio 1.008, 95% CI 1.001-1.02, P = 0.05), but MI was not. CONCLUSION: In LIFE patients, higher in-treatment BP6-24 months variability was independently of mean BP6-24 months associated with later CEP and stroke, but not with MI or TOD after 24 months.
Cite This Study
Vishram et al. (Thu,) conducted a rct in Hypertension with left ventricular hypertrophy (n=8,505). Blood pressure variability was evaluated on Composite endpoint of cardiovascular death, nonfatal myocardial infarction or stroke occurring after 24 months (HR 1.04, 95% CI 1.01-1.06, p=0.005). Higher in-treatment diastolic blood pressure variability independently predicted the composite of cardiovascular death, MI, or stroke (HR per 1 mmHg increase 1.04; 95% CI 1.01-1.06; P=0.005).