Visit-to-Visit Blood Pressure Variability and Mortality and Cardiovascular Outcomes Among Older Adults: The Health, Aging, and Body Composition Study.
BACKGROUND
Level of blood pressure (BP) is strongly associated with cardiovascular (CV) events and mortality. However, it is questionable whether mean BP can fully capture BP-related vascular risk. Increasing attention has been given to the value of visit-to-visit BP variability.


METHODS
We examined the association of visit-to-visit BP variability with mortality, incident myocardial infarction (MI), and incident stroke among 1,877 well-functioning elders in the Health, Aging, and Body Composition Study. We defined visit-to-visit diastolic BP (DBP) and systolic BP (SBP) variability as the root-mean-square error of person-specific linear regression of BP as a function of time. Alternatively, we counted the number of considerable BP increases and decreases (separately; 10mm Hg for DBP and 20mm Hg for SBP) between consecutive visits for each individual.


RESULTS
Over an average follow-up of 8.5 years, 623 deaths (207 from CV disease), 153 MIs, and 156 strokes occurred. The median visit-to-visit DBP and SBP variability was 4.96 mmHg and 8.53 mmHg, respectively. After multivariable adjustment, visit-to-visit DBP variability was related to higher all-cause (hazard ratio (HR) = 1.18 per 1 SD, 95% confidence interval (CI) = 1.01-1.37) and CV mortality (HR = 1.35, 95% CI = 1.05-1.73). Additionally, individuals having more considerable decreases of DBP (≥10mm Hg between 2 consecutive visits) had higher risk of all-cause (HR = 1.13, 95% CI = 0.99-1.28) and CV mortality (HR = 1.30, 95% CI = 1.05-1.61); considerable increases of SBP (≥20mm Hg) were associated with higher risk of all-cause (HR = 1.18, 95% CI = 1.03-1.36) and CV mortality (HR = 1.37, 95% CI = 1.08-1.74).


CONCLUSIONS
Visit-to-visit DBP variability and considerable changes in DBP and SBP were risk factors for mortality in the elderly.
School of Biological and Population Health Sciences, Oregon State University, Corvallis, Oregon, USA; wuche@oregonstate.edu.
Chenkai
C
Wu
Department of Medicine, University of California, San Francisco, California, USA.|Department of Medicine, Kidney Health Research Collaborative at the San Francisco VA Medical Center, San Francisco, California, USA.
Michael G
MG
Shlipak
School of Social and Human Health Sciences, Oregon State University, Corvallis, Oregon, USA.
Robert S
RS
Stawski
Department of Medicine, University of California, San Francisco, California, USA.|Department of Medicine, Kidney Health Research Collaborative at the San Francisco VA Medical Center, San Francisco, California, USA.
Carmen A
CA
Peralta
Bruce M
BM
Psaty
Intramural Research Program, Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, Maryland, USA.
Tamara B
TB
Harris
Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Suzanne
S
Satterfield
Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Eric J
EJ
Shiroma
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Anne B
AB
Newman
School of Biological and Population Health Sciences, Oregon State University, Corvallis, Oregon, USA.
Michelle C
MC
Odden
D000368:Aged; D000375:Aging; D001794:Blood Pressure / Q000502:physiology*; D001795:Blood Pressure Determination; D001823:Body Composition; D002140:California / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006304:Health Status; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology*; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D009819:Office Visits; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D015996:Survival Rate / Q000639:trends
aged.; blood pressure; blood pressure variability; hypertension; mortality; myocardial infarction; stroke