Association of Systolic Blood Pressure Variability With Mortality, Coronary Heart Disease, Stroke, and Renal Disease

Elvira O. Gosmanova, Margit K. Mikkelsen, Miklos Z. Molnar, Jun L. Lu, Lenar T. Yessayan, Kamyar Kalantar-Zadeh, Csaba Kovesdy

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

Background Intraindividual blood pressure (BP) fluctuates dynamically over time. Previous studies suggested an adverse link between greater visit-to-visit variability in systolic blood pressure (SBP) and various outcomes. However, these studies have significant limitations, such as a small size, inclusion of selected populations, and restricted outcomes. Objectives This study investigated the association of increased visit-to-visit variability and all-cause mortality, cardiovascular events, and end-stage renal disease (ESRD) in a large cohort of U.S. veterans. Methods From among 3,285,684 U.S. veterans with and without hypertension and normal estimated glomerular filtration rates (eGFR) during 2005 and 2006, we identified 2,865,157 patients who had 8 or more outpatient BP measurements. Systolic blood pressure variability (SBPV) was measured using the SD of all SBP values (normally distributed) in 1 individual. Associations of SD quartiles (<10.3, 10.3 to 12.7, 12.7 to 15.6, and ≥15.6 mm Hg) with all-cause mortality, incident coronary heart disease (CHD), stroke, and ESRD was examined using Cox models adjusted for sociodemographic characteristics, baseline eGFR, comorbidities, body mass index, SBP, diastolic BP, and antihypertensive medication use. Results Several sociodemographic variables (older age, male sex, African-American race, divorced or widowed status) and clinical characteristics (lower baseline eGFR, higher SBP and diastolic BP), and comorbidities (presence of diabetes, hypertension, cardiovascular disease, and lung disease) were all associated with higher intraindividual SBPV. The multivariable adjusted hazard ratios and 95% confidence intervals for SD quartiles 2 through 4 (compared with the first quartile) associated with all-cause mortality, CHD, stroke, and ESRD were incrementally higher. Conclusions Higher SBPV in individuals with and without hypertension was associated with increased risks of all-cause mortality, CHD, stroke, and ESRD. Further studies are needed to determine interventions that can lower SBPV and their impact on adverse health outcomes.

Original languageEnglish (US)
Pages (from-to)1375-1386
Number of pages12
JournalJournal of the American College of Cardiology
Volume68
Issue number13
DOIs
StatePublished - Sep 27 2016

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Stroke
Blood Pressure
Mortality
Chronic Kidney Failure
Hypertension
Glomerular Filtration Rate
Coronary Disease
Veterans
Comorbidity
Widowhood
Divorce
African Americans
Antihypertensive Agents
Lung Diseases
Body Mass Index
Outpatients
Cardiovascular Diseases
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Association of Systolic Blood Pressure Variability With Mortality, Coronary Heart Disease, Stroke, and Renal Disease. / Gosmanova, Elvira O.; Mikkelsen, Margit K.; Molnar, Miklos Z.; Lu, Jun L.; Yessayan, Lenar T.; Kalantar-Zadeh, Kamyar; Kovesdy, Csaba.

In: Journal of the American College of Cardiology, Vol. 68, No. 13, 27.09.2016, p. 1375-1386.

Research output: Contribution to journalArticle

Gosmanova, Elvira O. ; Mikkelsen, Margit K. ; Molnar, Miklos Z. ; Lu, Jun L. ; Yessayan, Lenar T. ; Kalantar-Zadeh, Kamyar ; Kovesdy, Csaba. / Association of Systolic Blood Pressure Variability With Mortality, Coronary Heart Disease, Stroke, and Renal Disease. In: Journal of the American College of Cardiology. 2016 ; Vol. 68, No. 13. pp. 1375-1386.
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AU - Gosmanova, Elvira O.

AU - Mikkelsen, Margit K.

AU - Molnar, Miklos Z.

AU - Lu, Jun L.

AU - Yessayan, Lenar T.

AU - Kalantar-Zadeh, Kamyar

AU - Kovesdy, Csaba

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N2 - Background Intraindividual blood pressure (BP) fluctuates dynamically over time. Previous studies suggested an adverse link between greater visit-to-visit variability in systolic blood pressure (SBP) and various outcomes. However, these studies have significant limitations, such as a small size, inclusion of selected populations, and restricted outcomes. Objectives This study investigated the association of increased visit-to-visit variability and all-cause mortality, cardiovascular events, and end-stage renal disease (ESRD) in a large cohort of U.S. veterans. Methods From among 3,285,684 U.S. veterans with and without hypertension and normal estimated glomerular filtration rates (eGFR) during 2005 and 2006, we identified 2,865,157 patients who had 8 or more outpatient BP measurements. Systolic blood pressure variability (SBPV) was measured using the SD of all SBP values (normally distributed) in 1 individual. Associations of SD quartiles (<10.3, 10.3 to 12.7, 12.7 to 15.6, and ≥15.6 mm Hg) with all-cause mortality, incident coronary heart disease (CHD), stroke, and ESRD was examined using Cox models adjusted for sociodemographic characteristics, baseline eGFR, comorbidities, body mass index, SBP, diastolic BP, and antihypertensive medication use. Results Several sociodemographic variables (older age, male sex, African-American race, divorced or widowed status) and clinical characteristics (lower baseline eGFR, higher SBP and diastolic BP), and comorbidities (presence of diabetes, hypertension, cardiovascular disease, and lung disease) were all associated with higher intraindividual SBPV. The multivariable adjusted hazard ratios and 95% confidence intervals for SD quartiles 2 through 4 (compared with the first quartile) associated with all-cause mortality, CHD, stroke, and ESRD were incrementally higher. Conclusions Higher SBPV in individuals with and without hypertension was associated with increased risks of all-cause mortality, CHD, stroke, and ESRD. Further studies are needed to determine interventions that can lower SBPV and their impact on adverse health outcomes.

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