Visit-to-visit variability of blood pressure and coronary heart disease, stroke, heart failure, and mortality a cohort study

Paul Muntner, Jeff Whittle, Amy I. Lynch, Lisandro D. Colantonio, Lara M. Simpson, Paula T. Einhorn, Emily B. Levitan, Paul K. Whelton, William Cushman, Gail T. Louis, Barry R. Davis, Suzanne Oparil

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Abstract

Background: Variability of blood pressure (BP) across outpatient visits is frequently dismissed as random fluctuation around a patient's underlying BP. Objective: To examine the association of visit-to-visit variability (VVV) of systolic BP (SBP) and diastolic BP with cardiovascular disease (CVD) and mortality outcomes. Design: Prospective cohort study. Setting: Post hoc analysis of ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial). Participants: 25 814 ALLHAT participants. Measurements: The VVV of SBP was defined as the SD across SBP measurements obtained at 7 visits conducted from 6 to 28 months after ALLHAT enrollment. Participants without CVD events during the first 28 months of follow-up were followed from the 28-month visit through the end of active ALLHAT follow-up. Outcomes included fatal coronary heart disease (CHD) or nonfatal myocardial infarction, all-cause mortality, stroke, and heart failure. Results: During follow-up, 1194 fatal CHD or nonfatal MI events, 1948 deaths, 606 strokes, and 921 heart failure events occurred. After multivariable adjustment, including for mean SBP, the hazard ratio comparing participants in the highest versus lowest quintile of SD of SBP (≥14.4 mm Hg vs. <6.5 mm Hg) was 1.30 (95% CI, 1.06 to 1.59) for fatal CHD or nonfatal MI, 1.58 (CI, 1.32 to 1.90) for all-cause mortality, 1.46 (CI, 1.06 to 2.01) for stroke, and 1.25 (CI, 0.97 to 1.61) for heart failure. Higher VVV of diastolic BP was also associated with CVD events and mortality. Limitation: Long-term outcomes were not available. Conclusion: Higher VVV of SBP is associated with an increased risk for CVD and mortality. Future studies should examine whether reducing VVV of BP lowers this risk.

Original languageEnglish (US)
Pages (from-to)329-338
Number of pages10
JournalAnnals of internal medicine
Volume163
Issue number5
DOIs
StatePublished - Sep 1 2015

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Coronary Disease
Cohort Studies
Heart Failure
Stroke
Blood Pressure
Mortality
Cardiovascular Diseases
Myocardial Infarction
Fatal Outcome
Antihypertensive Agents
Outpatients
Prospective Studies
Lipids

All Science Journal Classification (ASJC) codes

  • Internal Medicine

Cite this

Muntner, P., Whittle, J., Lynch, A. I., Colantonio, L. D., Simpson, L. M., Einhorn, P. T., ... Oparil, S. (2015). Visit-to-visit variability of blood pressure and coronary heart disease, stroke, heart failure, and mortality a cohort study. Annals of internal medicine, 163(5), 329-338. https://doi.org/10.7326/M14-2803

Visit-to-visit variability of blood pressure and coronary heart disease, stroke, heart failure, and mortality a cohort study. / Muntner, Paul; Whittle, Jeff; Lynch, Amy I.; Colantonio, Lisandro D.; Simpson, Lara M.; Einhorn, Paula T.; Levitan, Emily B.; Whelton, Paul K.; Cushman, William; Louis, Gail T.; Davis, Barry R.; Oparil, Suzanne.

In: Annals of internal medicine, Vol. 163, No. 5, 01.09.2015, p. 329-338.

Research output: Contribution to journalArticle

Muntner, P, Whittle, J, Lynch, AI, Colantonio, LD, Simpson, LM, Einhorn, PT, Levitan, EB, Whelton, PK, Cushman, W, Louis, GT, Davis, BR & Oparil, S 2015, 'Visit-to-visit variability of blood pressure and coronary heart disease, stroke, heart failure, and mortality a cohort study', Annals of internal medicine, vol. 163, no. 5, pp. 329-338. https://doi.org/10.7326/M14-2803
Muntner, Paul ; Whittle, Jeff ; Lynch, Amy I. ; Colantonio, Lisandro D. ; Simpson, Lara M. ; Einhorn, Paula T. ; Levitan, Emily B. ; Whelton, Paul K. ; Cushman, William ; Louis, Gail T. ; Davis, Barry R. ; Oparil, Suzanne. / Visit-to-visit variability of blood pressure and coronary heart disease, stroke, heart failure, and mortality a cohort study. In: Annals of internal medicine. 2015 ; Vol. 163, No. 5. pp. 329-338.
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abstract = "Background: Variability of blood pressure (BP) across outpatient visits is frequently dismissed as random fluctuation around a patient's underlying BP. Objective: To examine the association of visit-to-visit variability (VVV) of systolic BP (SBP) and diastolic BP with cardiovascular disease (CVD) and mortality outcomes. Design: Prospective cohort study. Setting: Post hoc analysis of ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial). Participants: 25 814 ALLHAT participants. Measurements: The VVV of SBP was defined as the SD across SBP measurements obtained at 7 visits conducted from 6 to 28 months after ALLHAT enrollment. Participants without CVD events during the first 28 months of follow-up were followed from the 28-month visit through the end of active ALLHAT follow-up. Outcomes included fatal coronary heart disease (CHD) or nonfatal myocardial infarction, all-cause mortality, stroke, and heart failure. Results: During follow-up, 1194 fatal CHD or nonfatal MI events, 1948 deaths, 606 strokes, and 921 heart failure events occurred. After multivariable adjustment, including for mean SBP, the hazard ratio comparing participants in the highest versus lowest quintile of SD of SBP (≥14.4 mm Hg vs. <6.5 mm Hg) was 1.30 (95{\%} CI, 1.06 to 1.59) for fatal CHD or nonfatal MI, 1.58 (CI, 1.32 to 1.90) for all-cause mortality, 1.46 (CI, 1.06 to 2.01) for stroke, and 1.25 (CI, 0.97 to 1.61) for heart failure. Higher VVV of diastolic BP was also associated with CVD events and mortality. Limitation: Long-term outcomes were not available. Conclusion: Higher VVV of SBP is associated with an increased risk for CVD and mortality. Future studies should examine whether reducing VVV of BP lowers this risk.",
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AU - Muntner, Paul

AU - Whittle, Jeff

AU - Lynch, Amy I.

AU - Colantonio, Lisandro D.

AU - Simpson, Lara M.

AU - Einhorn, Paula T.

AU - Levitan, Emily B.

AU - Whelton, Paul K.

AU - Cushman, William

AU - Louis, Gail T.

AU - Davis, Barry R.

AU - Oparil, Suzanne

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N2 - Background: Variability of blood pressure (BP) across outpatient visits is frequently dismissed as random fluctuation around a patient's underlying BP. Objective: To examine the association of visit-to-visit variability (VVV) of systolic BP (SBP) and diastolic BP with cardiovascular disease (CVD) and mortality outcomes. Design: Prospective cohort study. Setting: Post hoc analysis of ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial). Participants: 25 814 ALLHAT participants. Measurements: The VVV of SBP was defined as the SD across SBP measurements obtained at 7 visits conducted from 6 to 28 months after ALLHAT enrollment. Participants without CVD events during the first 28 months of follow-up were followed from the 28-month visit through the end of active ALLHAT follow-up. Outcomes included fatal coronary heart disease (CHD) or nonfatal myocardial infarction, all-cause mortality, stroke, and heart failure. Results: During follow-up, 1194 fatal CHD or nonfatal MI events, 1948 deaths, 606 strokes, and 921 heart failure events occurred. After multivariable adjustment, including for mean SBP, the hazard ratio comparing participants in the highest versus lowest quintile of SD of SBP (≥14.4 mm Hg vs. <6.5 mm Hg) was 1.30 (95% CI, 1.06 to 1.59) for fatal CHD or nonfatal MI, 1.58 (CI, 1.32 to 1.90) for all-cause mortality, 1.46 (CI, 1.06 to 2.01) for stroke, and 1.25 (CI, 0.97 to 1.61) for heart failure. Higher VVV of diastolic BP was also associated with CVD events and mortality. Limitation: Long-term outcomes were not available. Conclusion: Higher VVV of SBP is associated with an increased risk for CVD and mortality. Future studies should examine whether reducing VVV of BP lowers this risk.

AB - Background: Variability of blood pressure (BP) across outpatient visits is frequently dismissed as random fluctuation around a patient's underlying BP. Objective: To examine the association of visit-to-visit variability (VVV) of systolic BP (SBP) and diastolic BP with cardiovascular disease (CVD) and mortality outcomes. Design: Prospective cohort study. Setting: Post hoc analysis of ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial). Participants: 25 814 ALLHAT participants. Measurements: The VVV of SBP was defined as the SD across SBP measurements obtained at 7 visits conducted from 6 to 28 months after ALLHAT enrollment. Participants without CVD events during the first 28 months of follow-up were followed from the 28-month visit through the end of active ALLHAT follow-up. Outcomes included fatal coronary heart disease (CHD) or nonfatal myocardial infarction, all-cause mortality, stroke, and heart failure. Results: During follow-up, 1194 fatal CHD or nonfatal MI events, 1948 deaths, 606 strokes, and 921 heart failure events occurred. After multivariable adjustment, including for mean SBP, the hazard ratio comparing participants in the highest versus lowest quintile of SD of SBP (≥14.4 mm Hg vs. <6.5 mm Hg) was 1.30 (95% CI, 1.06 to 1.59) for fatal CHD or nonfatal MI, 1.58 (CI, 1.32 to 1.90) for all-cause mortality, 1.46 (CI, 1.06 to 2.01) for stroke, and 1.25 (CI, 0.97 to 1.61) for heart failure. Higher VVV of diastolic BP was also associated with CVD events and mortality. Limitation: Long-term outcomes were not available. Conclusion: Higher VVV of SBP is associated with an increased risk for CVD and mortality. Future studies should examine whether reducing VVV of BP lowers this risk.

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