ALBANY, NY—Within individual patients, blood pressure (BP) fluctuates dynamically over time, and previous clinical studies have suggested an adverse link between greater visit-to-visit variability in systolic blood pressure (SBP) and various outcomes, according to a new study.
According to an article in the Journal of the American College of Cardiology, these studies have had significant limitations, however, such as a small size, inclusion of selected populations and restricted outcomes.1
In response, Albany, NY, Stratton VAMC-led researchers investigated the association of increased visit-to-visit variability with all-cause mortality, cardiovascular events and end-stage renal disease (ESRD) in a large cohort of U.S. veterans.
From among 3,285,684 veterans with and without hypertension and normal estimated glomerular filtration rates (eGFR) during 2005 and 2006, the study team identified 2,865,157 patients who had eight or more outpatient BP measurements.
Systolic blood pressure variability (SBPV) was measured using the SD of all SBP values (normally distributed) in one individual. Researchers examined associations of SD quartiles (<10.3, 10.3 to 12.7, 12.7 to 15.6, and ≥15.6mmHg) with all-cause mortality, incident coronary heart disease (CHD), stroke and ESRD, adjusting for sociodemographic characteristics, baseline eGFR, comorbidities, body mass index, SBP, diastolic BP and antihypertensive medication use.
Results indicate that higher intraindividual SBPV was associated with several sociodemographic variables and clinical characteristics:
- Older age,
- Male sex,
- African-American race, and
- Divorced or widowed status
- Lower baseline eGFR,
- Higher SBP and diastolic BP, and
- Comorbidities, such as the presence of diabetes, hypertension, cardiovascular disease and lung disease.
“Higher SBPV in individuals with and without hypertension was associated with increased risks of all-cause mortality, CHD, stroke, and ESRD,” study authors concluded. “Further studies are needed to determine interventions that can lower SBPV and their impact on adverse health outcomes.”
1. Gosmanova EO, Mikkelsen MK, Molnar MZ, Lu JL, Yessayan LT, Kalantar-Zadeh K, Kovesdy CP. Association of Systolic Blood Pressure Variability With Mortality, Coronary Heart Disease, Stroke, and Renal Disease. J Am Coll Cardiol. 2016 Sep 27;68(13):1375-86. doi: 10.1016/j.jacc.2016.06.054. PubMed PMID: 27659458.
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