title: High Short-Term Blood Pressure Variability Predicts Long-Term Cardiovascular Mortality in Untreated Hypertensives But Not in Normotensives.
abstract: The prognostic value of the short-term blood pressure variability (BPV) from the 24-hour ambulatory blood pressure monitoring (ABPM) remains controversial. The present study aimed to investigate the long-term prognostic value of a high BPV in normotensive and hypertensive subjects from a community-based population.
  
  
  
  A cohort of 624 normotensive and 633 untreated hypertensive Taiwanese participants (overall 669 men, aged 30-79 years) with baseline ABPM and 20-year all-cause and cardiovascular mortality data was drawn from a community-based survey. BPV was assessed by the read-to-read average real variability of the 24-hour diastolic and systolic blood pressure (SBP) (ARVd and ARVs, respectively).
  
  
  
  In Cox proportional hazards analysis, ARVd predicted cardiovascular mortality independently of office SBP (hazard ratios (HRs) and 95% confidence intervals (CIs) per 1 SD: 1.31 (1.10-1.55), respectively, bivariate analysis), 24-hour SBP (HR: 1.19, 95% CI: 1.00-1.43), and conventional risk factors (age, sex, smoking, total cholesterol, high-density lipoprotein cholesterol, and fasting blood glucose, HR: 1.40, 95% CI: 1.18-1.67). In subjects with hypertension, a high vs. low ARVd (median: 8.8mm Hg) significantly predicted cardiovascular mortality (HR: 2.11, 95% CI: 1.23-3.62 and HR: 2.04, 95% CI: 1.19-3.51, respectively), when the conventional risk factors plus office SBP or 24-hour SBP were accounted for, respectively. Similar but less significant results were obtained with ARVs. A high ARVd or ARVs did not significantly predict cardiovascular mortality in the normotensive subjects.
  
  
  
  A high short-term BPV is significantly predictive of long-term cardiovascular mortality in untreated hypertensive but not normotensive community-based subjects, independently of office or 24-hour SBP.
authors.forename: Pai-Feng
authors.initials: PF
authors.lastname: Hsu
authors.forename: Hao-Min
authors.initials: HM
authors.lastname: Cheng
authors.affiliation: Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan;
authors.forename: Cheng-Hsueh
authors.initials: CH
authors.lastname: Wu
authors.forename: Shih-Hsien
authors.initials: SH
authors.lastname: Sung
authors.affiliation: National Health Research Institutes, Miaoli, Taiwan;
authors.forename: Shao-Yuan
authors.initials: SY
authors.lastname: Chuang
authors.affiliation: The Laboratory of Cardiovascular Science in the National Institute on Aging Intramural Research Program in Baltimore, Baltimore, Maryland, USA;
authors.forename: Edward G
authors.initials: EG
authors.lastname: Lakatta
authors.affiliation: Department of Biomedical Engineering, Washington University, St Louis, Missouri, USA.
authors.forename: Frank C P
authors.initials: FC
authors.lastname: Yin
authors.affiliation: Institute of Public Health, National Yang-Ming University, Taipei, Taiwan;
authors.forename: Pesus
authors.initials: P
authors.lastname: Chou
authors.affiliation: chench@vghtpe.gov.tw.
authors.forename: Chen-Huan
authors.initials: CH
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000401:mortality* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D013624:Taiwan / Q000453:epidemiology
keywords: ambulatory blood pressure; blood pressure variability; cardiovascular mortality; hypertension.
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