A prospective study of variability in systolic blood pressure and mortality in a rural Bangladeshi population cohort.
OBJECTIVE
Limited studies suggest that blood pressure variability over time is a risk factor of long-term cardiovascular outcomes. However, most of these were in populations with pre-existing cardiovascular diseases (CVD) and studies in general population are lacking.


METHODS
The study included 11,153 participants in a population-based, prospective cohort study in Araihazar, Bangladesh. Resting blood pressure was measured at baseline and every two years thereafter. Participants were followed up for an average of 6.5 years (2002-2009).


RESULTS
Male gender, older age, baseline systolic blood pressure (SBP), and absence of betel leaf use were independently positively associated with greater SBP variability over time. There was a significant association between SBP variability and the risk of death from overall CVD, especially from major CVD events. The positive association with the risk of death from any cause and stroke in age- and sex-adjusted models was attenuated in fully-adjusted models. In addition, the hazard ratio (HR) of stroke mortality was greater for individuals with both high baseline and high SBP variability. Similar patterns of HRs were observed for all-cause and CVD mortalities.


CONCLUSIONS
In this rural Bangladeshi population, variability in SBP contributes to the risk of death from CVD and may further potentiate the increased mortality risk associated with high SBP.
Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, NY, USA.
Lital
L
Yinon
Yu
Y
Chen
Faruque
F
Parvez
Sripal
S
Bangalore
Tariqul
T
Islam
Alauddin
A
Ahmed
Muhammad
M
Rakibuz-Zaman
Rabiul
R
Hasan
Golam
G
Sarwar
Habibul
H
Ahsan
D000328:Adult; D000367:Age Factors; D001459:Bangladesh / Q000453:epidemiology; D001794:Blood Pressure / Q000502:physiology; D002318:Cardiovascular Diseases / Q000401:mortality / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D009026:Mortality; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D012737:Sex Factors; D020521:Stroke / Q000401:mortality / Q000503:physiopathology
Blood pressure; Cardiovascular disease; Cerebrovascular disorders; Heart diseases; Mortality; Variability