TY - JOUR
T1 - Within-Subject Blood Pressure Level-Not Variability-Predicts Fatal and Nonfatal Outcomes in a General Population
AU - Schutte, Rudolph
AU - Thijs, Lutgarde
AU - Liu, Yan-Ping
AU - Asayama, Kei
AU - Jin, Yu
AU - Odili, Augustine
AU - Gu, Yu-Mei
AU - Kuznetsova, Tatiana
AU - Jacobs, Lotte
AU - Staessen, Jan A.
PY - 2012/11
Y1 - 2012/11
N2 - To assess the prognostic significance of blood pressure (BP) variability, we followed health outcomes in a family-based random population sample representative of the general population (n=2944; mean age: 44.9 years; 50.7% women). At baseline, BP was measured 5 times consecutively at each of 2 home visits 2 to 4 weeks apart. We assessed within-subject overall (10 readings), within-and between-visit systolic BP variability from variability independent of the mean, the difference between maximum and minimum BP, and average real variability. Over a median follow-up of 12 years, 401 deaths occurred and 311 participants experienced a fatal or nonfatal cardiovascular event. Overall systolic BP variability averaged (SD) 5.45 (2.82) units, 15.87 (8.36) mm Hg, and 4.08 (2.05) mm Hg for variability independent of the mean, difference between maximum and minimum BP, and average real variability, respectively. Female sex, older age, higher-mean systolic BP, lower body mass index, a history of peripheral arterial disease, and use of beta-blockers were the main correlates of systolic BP variability. In multivariable-adjusted analyses, overall and within-and between-visit BP variability did not predict total or cardiovascular mortality or the composite of any fatal plus nonfatal cardiovascular end point. For instance, the hazard ratios for all cardiovascular events combined in relation to overall variability independent of the mean, difference between maximum and minimum BP, and average real variability were 1.05 (0.96-1.15), 1.06 (0.96-1.16), and 1.08 (0.98-1.19), respectively. By contrast, mean systolic BP was a significant predictor of all end points under study, independent of BP variability. In conclusion, in an unbiased population sample, BP variability did not contribute to risk stratification over and beyond mean systolic BP. (Hypertension. 2012;60:1138-1147.). Online Data Supplement
AB - To assess the prognostic significance of blood pressure (BP) variability, we followed health outcomes in a family-based random population sample representative of the general population (n=2944; mean age: 44.9 years; 50.7% women). At baseline, BP was measured 5 times consecutively at each of 2 home visits 2 to 4 weeks apart. We assessed within-subject overall (10 readings), within-and between-visit systolic BP variability from variability independent of the mean, the difference between maximum and minimum BP, and average real variability. Over a median follow-up of 12 years, 401 deaths occurred and 311 participants experienced a fatal or nonfatal cardiovascular event. Overall systolic BP variability averaged (SD) 5.45 (2.82) units, 15.87 (8.36) mm Hg, and 4.08 (2.05) mm Hg for variability independent of the mean, difference between maximum and minimum BP, and average real variability, respectively. Female sex, older age, higher-mean systolic BP, lower body mass index, a history of peripheral arterial disease, and use of beta-blockers were the main correlates of systolic BP variability. In multivariable-adjusted analyses, overall and within-and between-visit BP variability did not predict total or cardiovascular mortality or the composite of any fatal plus nonfatal cardiovascular end point. For instance, the hazard ratios for all cardiovascular events combined in relation to overall variability independent of the mean, difference between maximum and minimum BP, and average real variability were 1.05 (0.96-1.15), 1.06 (0.96-1.16), and 1.08 (0.98-1.19), respectively. By contrast, mean systolic BP was a significant predictor of all end points under study, independent of BP variability. In conclusion, in an unbiased population sample, BP variability did not contribute to risk stratification over and beyond mean systolic BP. (Hypertension. 2012;60:1138-1147.). Online Data Supplement
KW - blood pressure variability
KW - cardiovascular disease
KW - population science
KW - risk factors
KW - epidemiology
U2 - 10.1161/HYPERTENSIONAHA.112.202143
DO - 10.1161/HYPERTENSIONAHA.112.202143
M3 - Article
C2 - 23071126
SN - 0194-911X
VL - 60
SP - 1138
EP - 1147
JO - Hypertension
JF - Hypertension
IS - 5
ER -