title: Association of Systolic Blood Pressure Variability With Mortality, Coronary Heart Disease, Stroke, and Renal Disease.
abstract: Intraindividual blood pressure (BP) fluctuates dynamically over time. Previous studies suggested an adverse link between greater visit-to-visit variability in systolic blood pressure (SBP) and various outcomes. However, these studies have significant limitations, such as a small size, inclusion of selected populations, and restricted outcomes.
  
  
  
  This study investigated the association of increased visit-to-visit variability and all-cause mortality, cardiovascular events, and end-stage renal disease (ESRD) in a large cohort of U.S. veterans.
  
  
  
  From among 3,285,684 U.S. veterans with and without hypertension and normal estimated glomerular filtration rates (eGFR) during 2005 and 2006, we identified 2,865,157 patients who had 8 or more outpatient BP measurements. Systolic blood pressure variability (SBPV) was measured using the SD of all SBP values (normally distributed) in 1 individual. Associations of SD quartiles (<10.3, 10.3 to 12.7, 12.7 to 15.6, and ≥15.6 mm Hg) with all-cause mortality, incident coronary heart disease (CHD), stroke, and ESRD was examined using Cox models adjusted for sociodemographic characteristics, baseline eGFR, comorbidities, body mass index, SBP, diastolic BP, and antihypertensive medication use.
  
  
  
  Several sociodemographic variables (older age, male sex, African-American race, divorced or widowed status) and clinical characteristics (lower baseline eGFR, higher SBP and diastolic BP), and comorbidities (presence of diabetes, hypertension, cardiovascular disease, and lung disease) were all associated with higher intraindividual SBPV. The multivariable adjusted hazard ratios and 95% confidence intervals for SD quartiles 2 through 4 (compared with the first quartile) associated with all-cause mortality, CHD, stroke, and ESRD were incrementally higher.
  
  
  
  Higher SBPV in individuals with and without hypertension was associated with increased risks of all-cause mortality, CHD, stroke, and ESRD. Further studies are needed to determine interventions that can lower SBPV and their impact on adverse health outcomes.
authors.affiliation: Nephrology Section, Stratton Veterans Affairs (VA) Medical Center, Albany, New York; Division of Nephrology, Albany Medical College, Albany, New York.
authors.forename: Elvira O
authors.initials: EO
authors.lastname: Gosmanova
authors.affiliation: University of Texas Health Science Center, San Antonio, Texas.
authors.forename: Margit K
authors.initials: MK
authors.lastname: Mikkelsen
authors.affiliation: Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Miklos Z
authors.initials: MZ
authors.lastname: Molnar
authors.affiliation: Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Jun L
authors.initials: JL
authors.lastname: Lu
authors.affiliation: Division of Nephrology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Lenar T
authors.initials: LT
authors.lastname: Yessayan
authors.affiliation: Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, California.
authors.forename: Kamyar
authors.initials: K
authors.lastname: Kalantar-Zadeh
authors.affiliation: Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee; Nephrology Section, Memphis VA Medical Center, Memphis, Tennessee. Electronic address: ckovesdy@uthsc.edu.
authors.forename: Csaba P
authors.initials: CP
authors.lastname: Kovesdy
mesh_terms: D001794:Blood Pressure; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000401:mortality* / Q000503:physiopathology*; D020521:Stroke / Q000150:complications / Q000401:mortality* / Q000503:physiopathology*; D014481:United States; D058014:Veterans Health
keywords: hypertension; outcomes; visit-to-visit variability