title: The impact of multiple single day blood pressure readings on cardiovascular risk estimation: The Atherosclerosis Risk in Communities study.
abstract: The aim of this study was to determine the magnitude of change in estimated cardiovascular disease risk when multiple same day blood pressure measurements are used in estimating coronary heart disease, heart failure and stroke risks.
  
  
  
  Black and White participants, N = 11,129, enrolled in the Atherosclerosis Risk in Communities study (mean age 53.9 ± 5.7 (SD) years) were included. Each participant had three sitting, five supine, and six standing blood pressure measures during one day. Main outcome measures were changes in estimated coronary heart disease, heart failure and stroke risk when using the different blood pressure measures. Mean sitting, standing and supine systolic blood pressure values of the study population were 120.8 ± 18.6, 124.9 ± 20 and 124.7 ± 19.6 mmHg, respectively. The substitution of the second sitting systolic blood pressure with the third sitting systolic blood pressure (taken ∼5 min later) in two separate coronary heart disease risk models reclassified 3.3% to 5.1% of study participants. Similar substitutions for heart failure and stroke risk prediction models led to reclassification of 1.9% and 2.7% of participants respectively. When mean sitting systolic blood pressure was replaced with mean standing systolic blood pressure 5.4% to 11.6% of the participants were reclassified. Maximum upward and downward change in an individual's estimated risk was 31% and 26% respectively.
  
  
  
  Estimated risks of coronary heart disease, heart failure, and stroke for an individual can change significantly within a day due to changes in systolic blood pressure. Given recommendations to use estimated risk for therapeutic decisions, our study has implications for the use of a single systolic blood pressure in cardiovascular risk estimation.
authors: The University of Texas Health Science Center at Houston, Texas, USA.
authors: Abayomi N
authors: AN
authors: Ogunwale
authors: The University of Texas Health Science Center at Houston, Texas, USA.
authors: Alanna C
authors: AC
authors: Morrison
authors: Baylor College of Medicine, Houston, Texas, USA.
authors: Wensheng
authors: W
authors: Sun
authors: MD Anderson Cancer Center, Houston, Texas, USA.
authors: Rhiannon C
authors: RC
authors: Dodge
authors: Baylor College of Medicine, Houston, Texas, USA Michael E DeBakey Veterans Affairs Hospital, Houston, Texas, USA Methodist Debakey Heart and Vascular Center, Houston, Texas, USA.
authors: Salim S
authors: SS
authors: Virani
authors: Baylor College of Medicine, Houston, Texas, USA Michael E DeBakey Veterans Affairs Hospital, Houston, Texas, USA.
authors: Addison
authors: A
authors: Taylor
authors: Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: Rebecca F
authors: RF
authors: Gottesman
authors: Baylor College of Medicine, Houston, Texas, USA.
authors: Eric
authors: E
authors: Yang
authors: The University of Texas Health Science Center at Houston, Texas, USA.
authors: Peng
authors: P
authors: Wei
authors: Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: John W
authors: JW
authors: McEvoy
authors: University of North Carolina at Chapel Hill, NC, USA.
authors: Gerardo
authors: G
authors: Heiss
authors: The University of Texas Health Science Center at Houston, Texas, USA Baylor College of Medicine, Houston, Texas, USA Human Genome Sequencing Center, Houston, Texas, USA Institute of Molecular Medicine, Houston, Texas, USA.
authors: Eric
authors: E
authors: Boerwinkle
authors: Baylor College of Medicine, Houston, Texas, USA Methodist Debakey Heart and Vascular Center, Houston, Texas, USA.
authors: Christie M
authors: CM
authors: Ballantyne
authors: Baylor College of Medicine, Houston, Texas, USA Michael E DeBakey Veterans Affairs Hospital, Houston, Texas, USA Methodist Debakey Heart and Vascular Center, Houston, Texas, USA vnambi@bcm.tmc.edu.
authors: Vijay
authors: V
authors: Nambi
mesh_terms: D050197:Atherosclerosis / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D001794:Blood Pressure / Q000502:physiology*; D001795:Blood Pressure Determination / Q000379:methods*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
keywords: ARIC; ASCVD; Blood pressure; CVD risk reclassification