title: Redefined blood pressure variability measure and its association with mortality in elderly primary care patients.
abstract: Visit-to-visit blood pressure (BP) variability has received considerable attention recently. The objective of our study is to define a variability measure that is independent of change over time and determine the association between longitudinal summary measures of BP measurements and mortality risk. Data for the study came from a prospective cohort of 2906 adults, aged ≥60 years, in an urban primary care system with ≤15 years of follow-up. Dates of death for deceased participants were retrieved from the National Death Index. Systolic and diastolic BP measurements from outpatient clinic visits were extracted from the Regenstrief Medical Record System. For each patient, the intercept, regression slope, and root mean square error for visit-to-visit variability were derived using linear regression models and used as independent variables in Cox proportional hazards models for both all-cause mortality and mortality attributable to coronary heart disease or stroke. Rate of change was associated with mortality risk in a U-shaped relationship and that participants with little or no change in BP had the lowest mortality risk. BP variability was not an independent predictor of mortality risk. By separating change over time from visit-to-visit variability in studies with relatively long follow-up, we demonstrated in this elderly primary care patient population that BP changes over time, not variability, were associated with greater mortality risk. Future research is needed to confirm our findings in other populations.
authors.affiliation: From the Departments of Biostatistics (S.G., C.W., T.E.S.), Psychiatry (H.C.H.), and Medicine (C.M.C.), Indiana University School of Medicine, Indianapolis; Department of Biostatistics, Richard M. Fairbank School of Public Health, Indiana University, Indianapolis (S.G., C.W.); Regenstrief Institute Inc, Indianapolis, IN (H.C.H., J.K., D.O.C., C.M.C.); Indiana University Center for Aging Research, Indianapolis (S.G., H.C.H., D.O.C., C.M.C.); and Department of Psychology, Indiana University-Purdue University Indianapolis (J.C.S.). sgao@iu.edu.
authors.forename: Sujuan
authors.initials: S
authors.lastname: Gao
authors.affiliation: From the Departments of Biostatistics (S.G., C.W., T.E.S.), Psychiatry (H.C.H.), and Medicine (C.M.C.), Indiana University School of Medicine, Indianapolis; Department of Biostatistics, Richard M. Fairbank School of Public Health, Indiana University, Indianapolis (S.G., C.W.); Regenstrief Institute Inc, Indianapolis, IN (H.C.H., J.K., D.O.C., C.M.C.); Indiana University Center for Aging Research, Indianapolis (S.G., H.C.H., D.O.C., C.M.C.); and Department of Psychology, Indiana University-Purdue University Indianapolis (J.C.S.).
authors.forename: Hugh C
authors.initials: HC
authors.lastname: Hendrie
authors.affiliation: From the Departments of Biostatistics (S.G., C.W., T.E.S.), Psychiatry (H.C.H.), and Medicine (C.M.C.), Indiana University School of Medicine, Indianapolis; Department of Biostatistics, Richard M. Fairbank School of Public Health, Indiana University, Indianapolis (S.G., C.W.); Regenstrief Institute Inc, Indianapolis, IN (H.C.H., J.K., D.O.C., C.M.C.); Indiana University Center for Aging Research, Indianapolis (S.G., H.C.H., D.O.C., C.M.C.); and Department of Psychology, Indiana University-Purdue University Indianapolis (J.C.S.).
authors.forename: Chenkun
authors.initials: C
authors.lastname: Wang
authors.affiliation: From the Departments of Biostatistics (S.G., C.W., T.E.S.), Psychiatry (H.C.H.), and Medicine (C.M.C.), Indiana University School of Medicine, Indianapolis; Department of Biostatistics, Richard M. Fairbank School of Public Health, Indiana University, Indianapolis (S.G., C.W.); Regenstrief Institute Inc, Indianapolis, IN (H.C.H., J.K., D.O.C., C.M.C.); Indiana University Center for Aging Research, Indianapolis (S.G., H.C.H., D.O.C., C.M.C.); and Department of Psychology, Indiana University-Purdue University Indianapolis (J.C.S.).
authors.forename: Timothy E
authors.initials: TE
authors.lastname: Stump
authors.affiliation: From the Departments of Biostatistics (S.G., C.W., T.E.S.), Psychiatry (H.C.H.), and Medicine (C.M.C.), Indiana University School of Medicine, Indianapolis; Department of Biostatistics, Richard M. Fairbank School of Public Health, Indiana University, Indianapolis (S.G., C.W.); Regenstrief Institute Inc, Indianapolis, IN (H.C.H., J.K., D.O.C., C.M.C.); Indiana University Center for Aging Research, Indianapolis (S.G., H.C.H., D.O.C., C.M.C.); and Department of Psychology, Indiana University-Purdue University Indianapolis (J.C.S.).
authors.forename: Jesse C
authors.initials: JC
authors.lastname: Stewart
authors.affiliation: From the Departments of Biostatistics (S.G., C.W., T.E.S.), Psychiatry (H.C.H.), and Medicine (C.M.C.), Indiana University School of Medicine, Indianapolis; Department of Biostatistics, Richard M. Fairbank School of Public Health, Indiana University, Indianapolis (S.G., C.W.); Regenstrief Institute Inc, Indianapolis, IN (H.C.H., J.K., D.O.C., C.M.C.); Indiana University Center for Aging Research, Indianapolis (S.G., H.C.H., D.O.C., C.M.C.); and Department of Psychology, Indiana University-Purdue University Indianapolis (J.C.S.).
authors.forename: Joe
authors.initials: J
authors.lastname: Kesterson
authors.affiliation: From the Departments of Biostatistics (S.G., C.W., T.E.S.), Psychiatry (H.C.H.), and Medicine (C.M.C.), Indiana University School of Medicine, Indianapolis; Department of Biostatistics, Richard M. Fairbank School of Public Health, Indiana University, Indianapolis (S.G., C.W.); Regenstrief Institute Inc, Indianapolis, IN (H.C.H., J.K., D.O.C., C.M.C.); Indiana University Center for Aging Research, Indianapolis (S.G., H.C.H., D.O.C., C.M.C.); and Department of Psychology, Indiana University-Purdue University Indianapolis (J.C.S.).
authors.forename: Daniel O
authors.initials: DO
authors.lastname: Clark
authors.affiliation: From the Departments of Biostatistics (S.G., C.W., T.E.S.), Psychiatry (H.C.H.), and Medicine (C.M.C.), Indiana University School of Medicine, Indianapolis; Department of Biostatistics, Richard M. Fairbank School of Public Health, Indiana University, Indianapolis (S.G., C.W.); Regenstrief Institute Inc, Indianapolis, IN (H.C.H., J.K., D.O.C., C.M.C.); Indiana University Center for Aging Research, Indianapolis (S.G., H.C.H., D.O.C., C.M.C.); and Department of Psychology, Indiana University-Purdue University Indianapolis (J.C.S.).
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Callahan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology*; D001795:Blood Pressure Determination; D002318:Cardiovascular Diseases / Q000401:mortality* / Q000503:physiopathology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000401:mortality* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D011320:Primary Health Care; D011446:Prospective Studies; D012306:Risk
keywords: blood pressure; cardiovascular diseases; cohort studies; mortality