title: The prognostic value of long-term visit-to-visit blood pressure variability on stroke in real-world practice: a dynamic cohort study in a large representative sample of Chinese hypertensive population.
abstract: BACKGROUND
  The prognostic significance of long-term visit-to-visit blood pressure variability (BPV) has not yet been validated in "real world" hypertensive patients. The aim of the current study is to explore the prognostic value of BPV on stroke in hypertensive patients.
  
  
  METHODS
  This was a dynamic prospective cohort study based on electronic medical records in Shanghai, China. Hypertensive patients (N=122,636) without history of stroke at baseline, were followed up from 2005 to 2011. The cohort comprised of 4522 stroke patients and 118,114 non-stroke patients during a mean follow-up duration of 48 months. BPV was measured by standard deviation (SD) and the coefficient of variation (CV) of blood pressure.
  
  
  RESULTS
  The visit-to-visit variability of both systolic blood pressure (SBP) and diastolic blood pressure (DBP) was independently associated with the occurrence of stroke [SD: the hazard ratios (95% confidence intervals) of SBP and DBP were 1.042 (1.021 to 1.064) and 1.052 (1.040 to 1.065); CV: the hazard ratios (95% confidence intervals) of SBP and DBP were 1.183 (1.010 to 1.356) and 1.151 (1.005 to 1.317), respectively]. The hazard ratio values increased along with an increase of the BPV levels of SBP and DBP. The increment effect remained significant after controlling the blood pressure control status of subjects.
  
  
  CONCLUSIONS
  Increased BPV of both SBP and DBP, independent of the average blood pressure, is a predictor of stroke among community hypertensive patients in real-world clinical practice. The risk of stroke increased along with increased BPV. Stabilizing BPV might be a therapeutic target in hypertension.
authors.affiliation: Institute of Clinical Epidemiology, Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai, China. Electronic address: jmyfudan@163.com.
authors.forename: Jin-ming
authors.initials: JM
authors.lastname: Yu
authors.affiliation: Institute of Clinical Epidemiology, Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai, China.
authors.forename: Qun-yu
authors.initials: QY
authors.lastname: Kong
authors.affiliation: Cleveland Clinic, Imaging Institute and Heart & Vascular Institute, Cleveland, OH, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Schoenhagen
authors.affiliation: Institute of Clinical Epidemiology, Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai, China.
authors.forename: Tian
authors.initials: T
authors.lastname: Shen
authors.affiliation: Medical Affairs of Great China Region of Novartis, Beijing, China.
authors.forename: Yu-song
authors.initials: YS
authors.lastname: He
authors.affiliation: Institute of Clinical Epidemiology, Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai, China.
authors.forename: Ji-wei
authors.initials: JW
authors.lastname: Wang
authors.affiliation: Shanghai Minhang Center for Disease Control and Prevention, Shanghai, China.
authors.forename: Yan-ping
authors.initials: YP
authors.lastname: Zhao
authors.affiliation: Medical Affairs of Great China Region of Novartis, Beijing, China.
authors.forename: Dan-ni
authors.initials: DN
authors.lastname: Shi
authors.affiliation: Department of Science and Education, Affiliated Mental Health Center, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Bao-liang
authors.initials: BL
authors.lastname: Zhong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology*; D001795:Blood Pressure Determination / Q000379:methods*; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D011159:Population Surveillance / Q000379:methods; D011379:Prognosis; D011446:Prospective Studies; D013997:Time Factors
keywords: Blood pressure variability; Cohort; Hypertension; Stroke