Long-term and ultra-long term blood pressure variability during follow–up and mortality in 14522 patients with hypertension

Hastie, C. et al. (2013) Long-term and ultra-long term blood pressure variability during follow–up and mortality in 14522 patients with hypertension. Hypertension, 62(4), pp. 698-705. (doi:10.1161/HYPERTENSIONAHA.113.01343) (PMID:23959561)

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Abstract

Recent evidence indicates that long-term visit-to-visit blood pressure variability (BPV) may be an independent cardiovascular risk predictor. The implication of this variability in hypertension clinical practice is unclear. BPV as average real variability (ARV) was calculated in 14 522 treated patients with hypertension in 4 time frames: year 1 (Y<sub>1</sub>), years 2 to 5 (Y<sub>2–5</sub>), years 5 to 10 (Y<sub>5–10</sub>), and years > 10 (Y<sub>10+</sub>) from first clinic visit. Cox proportional hazards models for cause-specific mortality were used in each time frame separately for long-term BPV, across time frames based on ultra long–term BPV, and within each time frame stratified by mean BP. ARV in systolic blood pressure (SBP), termed ARV<sub>SBP</sub>, was higher in Y<sub>1</sub>(21.3±11.9 mm Hg) in contrast to Y<sub>2–5</sub> (17.7±9.9 mm Hg), Y<sub>5–10</sub> (17.4±9.6 mm Hg), and Y<sub>10+</sub> (16.8±8.5 mm Hg). In all time frames, ARV<sub>SBP</sub> was higher in women (P >0.01) and in older age (P >0.001), chronic kidney disease (P >0.01), and prevalent cardiovascular disease (P >0.01). Higher long-term and ultra long–term BPV values were associated with increased mortality (all-cause, cardiovascular, and noncardiovascular mortality; P for trend, <0.001). This relationship was also evident in subgroups with mean SBP <140 mm Hg in all time frames. Monitoring BPV in clinical practice may facilitate risk reduction strategies by identifying treated hypertensive individuals at high risk, especially those with BP within the normal range.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Hastie, Dr Claire and Padmanabhan, Professor Sandosh and Dominiczak, Professor Anna and Sloan, Mr William and Mccallum, Dr Linsay and McInnes, Professor Gordon and Walters, Professor Matthew
Authors: Hastie, C., Jeemon, P., Coleman, H., McCallum, L., Patel, R., Dawson, J., Sloan, W., Meredith, P., Jones, G.C., Muir, S., Walters, M., Dominiczak, A.F., Morrison, D., McInnes, G.T., and Padmanabhan, S.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Public Health
Journal Name:Hypertension
Publisher:American Heart Association
ISSN:0194-911X
ISSN (Online):1524-4563

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