title: Visit-to-visit variability of blood pressure and cardiovascular disease and all-cause mortality: a systematic review and meta-analysis.
abstract: Visit-to-visit variability of blood pressure (BP) has been associated with cardiovascular disease (CVD) and mortality in some but not all studies. We conducted a systematic review and meta-analysis to examine the association between visit-to-visit variability of BP and CVD and all-cause mortality. Medical databases were searched through June 4, 2014, for studies meeting the following eligibility criteria: adult participants; BP measurements at ≥3 visits; follow-up for CVD, coronary heart disease, stroke, or mortality outcomes; events confirmed via database, death certificate, or event ascertainment committee; and adjustment for confounders. Data were extracted by 2 reviewers and pooled using a random-effects model. Overall, 8870 abstracts were identified of which 37 studies, representing 41 separate cohorts, met inclusion criteria. Across studies, visit-to-visit variability of systolic BP and diastolic BP showed significant associations with outcomes in 181 of 312 (58.0%) and 61 of 188 (32.4%) analyses, respectively. Few studies provided sufficient data for pooling risk estimates. For each 5 mm Hg higher SD of systolic BP, the pooled hazard ratio for stroke across 7 cohorts was 1.17 (95% confidence interval [CI], 1.07-1.28), for coronary heart disease across 4 cohorts was 1.27 (95% CI, 1.07-1.51), for CVD across 5 cohorts was 1.12 (95% CI, 0.98-1.28), for CVD mortality across 5 cohorts was 1.22 (95% CI, 1.09-1.35), and for all-cause mortality across 4 cohorts was 1.20 (95% CI, 1.05-1.36). In summary, modest associations between visit-to-visit variability of BP and CVD and all-cause mortality are present in published studies. However, these findings are limited by the small amount of data available for meta-analysis.
authors: From the Department of Medicine, Columbia University Medical Center, New York, NY (K.M.D., L.F., D.S.); Department of Epidemiology, University of Alabama at Birmingham (R.M.T., E.B.L., P.M.); and Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA (K.R.). kd2442@columbia.edu.
authors: Keith M
authors: KM
authors: Diaz
authors: From the Department of Medicine, Columbia University Medical Center, New York, NY (K.M.D., L.F., D.S.); Department of Epidemiology, University of Alabama at Birmingham (R.M.T., E.B.L., P.M.); and Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA (K.R.).
authors: Rikki M
authors: RM
authors: Tanner
authors: From the Department of Medicine, Columbia University Medical Center, New York, NY (K.M.D., L.F., D.S.); Department of Epidemiology, University of Alabama at Birmingham (R.M.T., E.B.L., P.M.); and Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA (K.R.).
authors: Louise
authors: L
authors: Falzon
authors: From the Department of Medicine, Columbia University Medical Center, New York, NY (K.M.D., L.F., D.S.); Department of Epidemiology, University of Alabama at Birmingham (R.M.T., E.B.L., P.M.); and Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA (K.R.).
authors: Emily B
authors: EB
authors: Levitan
authors: From the Department of Medicine, Columbia University Medical Center, New York, NY (K.M.D., L.F., D.S.); Department of Epidemiology, University of Alabama at Birmingham (R.M.T., E.B.L., P.M.); and Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA (K.R.).
authors: Kristi
authors: K
authors: Reynolds
authors: From the Department of Medicine, Columbia University Medical Center, New York, NY (K.M.D., L.F., D.S.); Department of Epidemiology, University of Alabama at Birmingham (R.M.T., E.B.L., P.M.); and Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA (K.R.).
authors: Daichi
authors: D
authors: Shimbo
authors: From the Department of Medicine, Columbia University Medical Center, New York, NY (K.M.D., L.F., D.S.); Department of Epidemiology, University of Alabama at Birmingham (R.M.T., E.B.L., P.M.); and Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA (K.R.).
authors: Paul
authors: P
authors: Muntner
mesh_terms: D001794:Blood Pressure / Q000502:physiology*; D015924:Blood Pressure Monitors; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality*; D003327:Coronary Disease / Q000453:epidemiology / Q000401:mortality; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D009026:Mortality; D009819:Office Visits; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000401:mortality; D015996:Survival Rate
keywords: blood pressure; cardiovascular diseases; meta-analysis; mortality; review