High Short-Term Blood Pressure Variability Predicts Long-Term Cardiovascular Mortality in Untreated Hypertensives But Not in Normotensives

Pai-Feng Hsu; Hao-Min Cheng; Cheng-Hsueh Wu; Shih-Hsien Sung; Shao-Yuan Chuang; Edward G Lakatta; Frank C P Yin; Pesus Chou; Chen-Huan Chen

doi:10.1093/ajh/hpw002

High Short-Term Blood Pressure Variability Predicts Long-Term Cardiovascular Mortality in Untreated Hypertensives But Not in Normotensives

Am J Hypertens. 2016 Jul;29(7):806-13. doi: 10.1093/ajh/hpw002. Epub 2016 Feb 1.

Authors

Pai-Feng Hsu, Hao-Min Cheng, Cheng-Hsueh Wu¹, Shih-Hsien Sung, Shao-Yuan Chuang², Edward G Lakatta³, Frank C P Yin⁴, Pesus Chou⁵, Chen-Huan Chen⁶

Affiliations

¹ Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan;
² National Health Research Institutes, Miaoli, Taiwan;
³ The Laboratory of Cardiovascular Science in the National Institute on Aging Intramural Research Program in Baltimore, Baltimore, Maryland, USA;
⁴ Department of Biomedical Engineering, Washington University, St Louis, Missouri, USA.
⁵ Institute of Public Health, National Yang-Ming University, Taipei, Taiwan;
⁶ chench@vghtpe.gov.tw.

Abstract

Background: The prognostic value of the short-term blood pressure variability (BPV) from the 24-hour ambulatory blood pressure monitoring (ABPM) remains controversial. The present study aimed to investigate the long-term prognostic value of a high BPV in normotensive and hypertensive subjects from a community-based population.

Methods: A cohort of 624 normotensive and 633 untreated hypertensive Taiwanese participants (overall 669 men, aged 30-79 years) with baseline ABPM and 20-year all-cause and cardiovascular mortality data was drawn from a community-based survey. BPV was assessed by the read-to-read average real variability of the 24-hour diastolic and systolic blood pressure (SBP) (ARVd and ARVs, respectively).

Results: In Cox proportional hazards analysis, ARVd predicted cardiovascular mortality independently of office SBP (hazard ratios (HRs) and 95% confidence intervals (CIs) per 1 SD: 1.31 (1.10-1.55), respectively, bivariate analysis), 24-hour SBP (HR: 1.19, 95% CI: 1.00-1.43), and conventional risk factors (age, sex, smoking, total cholesterol, high-density lipoprotein cholesterol, and fasting blood glucose, HR: 1.40, 95% CI: 1.18-1.67). In subjects with hypertension, a high vs. low ARVd (median: 8.8mm Hg) significantly predicted cardiovascular mortality (HR: 2.11, 95% CI: 1.23-3.62 and HR: 2.04, 95% CI: 1.19-3.51, respectively), when the conventional risk factors plus office SBP or 24-hour SBP were accounted for, respectively. Similar but less significant results were obtained with ARVs. A high ARVd or ARVs did not significantly predict cardiovascular mortality in the normotensive subjects.

Conclusions: A high short-term BPV is significantly predictive of long-term cardiovascular mortality in untreated hypertensive but not normotensive community-based subjects, independently of office or 24-hour SBP.

Keywords: ambulatory blood pressure; blood pressure variability; cardiovascular mortality; hypertension..

Publication types

Research Support, N.I.H., Intramural
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Blood Pressure*
Cohort Studies
Female
Humans
Hypertension / mortality*
Hypertension / physiopathology
Male
Middle Aged
Taiwan / epidemiology