title: Long-term and ultra long-term blood pressure variability during follow-up and mortality in 14,522 patients with hypertension.
abstract: Recent evidence indicates that long-term visit-to-visit blood pressure variability (BPV) may be an independent cardiovascular risk predictor. The implication of this variability in hypertension clinical practice is unclear. BPV as average real variability (ARV) was calculated in 14,522 treated patients with hypertension in 4 time frames: year 1 (Y1), years 2 to 5 (Y2-5), years 5 to 10 (Y5-10), and years >10 (Y10+) from first clinic visit. Cox proportional hazards models for cause-specific mortality were used in each time frame separately for long-term BPV, across time frames based on ultra long-term BPV, and within each time frame stratified by mean BP. ARV in systolic blood pressure (SBP), termed ARV(SBP), was higher in Y1 (21.3±11.9 mm Hg) in contrast to Y2-5 (17.7±9.9 mm Hg), Y5-10 (17.4±9.6 mm Hg), and Y10+ (16.8±8.5 mm Hg). In all time frames, ARV(SBP) was higher in women (P<0.01) and in older age (P<0.001), chronic kidney disease (P<0.01), and prevalent cardiovascular disease (P<0.01). Higher long-term and ultra long-term BPV values were associated with increased mortality (all-cause, cardiovascular, and noncardiovascular mortality; P for trend, <0.001). This relationship was also evident in subgroups with mean SBP<140 mm Hg in all time frames. Monitoring BPV in clinical practice may facilitate risk reduction strategies by identifying treated hypertensive individuals at high risk, especially those with BP within the normal range.
authors: BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8TA, United Kingdom. sandosh.padmanabhan@glasgow.ac.uk.
authors: Claire E
authors: CE
authors: Hastie
authors: Panniyammakal
authors: P
authors: Jeemon
authors: Holli
authors: H
authors: Coleman
authors: Linsay
authors: L
authors: McCallum
authors: Rajan
authors: R
authors: Patel
authors: Jesse
authors: J
authors: Dawson
authors: William
authors: W
authors: Sloan
authors: Peter
authors: P
authors: Meredith
authors: Gregory C
authors: GC
authors: Jones
authors: Scott
authors: S
authors: Muir
authors: Matthew
authors: M
authors: Walters
authors: Anna F
authors: AF
authors: Dominiczak
authors: David
authors: D
authors: Morrison
authors: Gordon T
authors: GT
authors: McInnes
authors: Sandosh
authors: S
authors: Padmanabhan
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology*; D001795:Blood Pressure Determination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000401:mortality / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012306:Risk; D012737:Sex Factors
keywords: blood pressure; blood pressure variability; epidemiology; hypertension; mortality