title: Impact of blood pressure variability on cardiovascular events in elderly patients with hypertension.
abstract: Blood pressure variability is one of the characteristic features of hypertension in the elderly. However, its clinical significance remains to be determined. We therefore examined the impact of blood pressure variability on the development of cardiovascular events in elderly hypertensive patients. A total of 106 consecutive hypertensive patients aged more than 60 years old (mean age, 73.9 +/- 8.1 years old; male, 54%), all of whom underwent 24-h ambulatory blood pressure monitoring, were followed up (median, 34 months; range, 3-60 months). During the follow-up period, 39 cardiovascular events were observed, including 14 cases of cerebral infarction and 7 cases of acute myocardial infarction. The coefficient of variation (CV) of 24-h systolic blood pressure (SBP) values was used as an index of blood pressure variability. The patients showed a mean CV value of 10.6%, and were divided into two groups according to this mean value as a cut-off point: a high CV group (n = 46) and a low CV group (n = 60). Although baseline clinical characteristics were similar in the two groups, Kaplan-Meier plots for event-free survival revealed that the rate of cardiovascular events was significantly higher in high CV group than in low CV group (p < 0.05). Cox's proportional hazards analysis showed that increased blood pressure variability (a high CV value of 24-h SBP) was an independent predictive variable for cardiovascular events. The CV value of daytime SBP and the SD value of both 24-h SBP and daytime SBP also had positive correlations with the onset of cardiovascular events. These results suggest that increased blood pressure variability may be an independent risk factor for cardiovascular events in elderly hypertensive patients.
authors.affiliation: Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Eto
authors.forename: Kenji
authors.initials: K
authors.lastname: Toba
authors.forename: Masahiro
authors.initials: M
authors.lastname: Akishita
authors.forename: Koichi
authors.initials: K
authors.lastname: Kozaki
authors.forename: Tokumitsu
authors.initials: T
authors.lastname: Watanabe
authors.forename: Seungbum
authors.initials: S
authors.lastname: Kim
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Hashimoto
authors.forename: Junya
authors.initials: J
authors.lastname: Ako
authors.forename: Katsuya
authors.initials: K
authors.lastname: Iijima
authors.forename: Noriko
authors.initials: N
authors.lastname: Sudoh
authors.forename: Masao
authors.initials: M
authors.lastname: Yoshizumi
authors.forename: Yasuyoshi
authors.initials: Y
authors.lastname: Ouchi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D002544:Cerebral Infarction / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012307:Risk Factors