title: Blood pressure variability and the risk of all-cause mortality, incident myocardial infarction, and incident stroke in the cardiovascular health study.
abstract: BACKGROUND
  Recent reports have linked variability in visit-to-visit systolic blood pressure (SBP) to risk of mortality and stroke, independent of the effect of mean SBP level. This study aimed to evaluate whether variability in SBP is associated with all-cause mortality, incident myocardial infarction (MI), and incident stroke, independent of mean SBP or trends in SBP levels over time.
  
  
  METHODS
  The Cardiovascular Health Study is a longitudinal cohort study of vascular risk factors and disease in the elderly. Participants who attended their first 5 annual clinic visits and experienced no event before the 5th visit were eligible (n = 3,852). Primary analyses were restricted to participants not using antihypertensive medications throughout the first 5 clinic visits (n = 1,642). Intraindividual SBP variables were defined using each participant's 5-visit blood pressure measures. Cox proportional hazards models estimated adjusted hazard ratios (HRs) per SD increase in intraindividual SBP variability, adjusted for intraindividual SBP mean and change over time.
  
  
  RESULTS
  Over a mean follow-up of 9.9 years, there were 844 deaths, 203 MIs, and 195 strokes. Intraindividual SBP variability was significantly associated with increased risk of mortality (HR = 1.13; 95% confidence interval (CI) = 1.05-1.21) and of incident MI (HR = 1.20; 95%CI = 1.06-1.36), independent of the effect from adjustment factors. Intraindividual SBP variability was not associated with risk of stroke (HR = 1.03; 95% CI = 0.89-1.21).
  
  
  CONCLUSIONS
  Long-term visit-to-visit SBP variability was independently associated with a higher risk of subsequent mortality and MI but not stroke. More research is needed to determine the relationship of BP variability with cardiovascular risk and the clinical implications.
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, Washington;
authors.forename: Astrid M
authors.initials: AM
authors.lastname: Suchy-Dicey
authors.forename: Erin R
authors.initials: ER
authors.lastname: Wallace
authors.forename: S V Elkind
authors.initials: SV
authors.lastname: Mitchell
authors.forename: Maria
authors.initials: M
authors.lastname: Aguilar
authors.forename: Rebecca F
authors.initials: RF
authors.lastname: Gottesman
authors.forename: Kenneth
authors.initials: K
authors.lastname: Rice
authors.forename: Richard
authors.initials: R
authors.lastname: Kronmal
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Psaty
authors.forename: W T
authors.initials: WT
authors.lastname: Longstreth
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D009026:Mortality; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000209:etiology; D012306:Risk; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology; D014481:United States / Q000453:epidemiology
keywords: blood pressure; blood pressure variability; hypertension; mortality; myocardial infarction; stroke.