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Atasoy S, Henningsen P, Johar H, Middeke M, Sattel H, Linkohr B, Rückert-Eheberg IM, Heier M, Peters A, Ladwig KH. Hypertension in the first blood pressure reading and the risk of cardiovascular disease mortality in the general population: findings from the prospective KORA study. J Hypertens 2024; 42:521-529. [PMID: 38088424 DOI: 10.1097/hjh.0000000000003629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
BACKGROUND The risk of cardiovascular disease (CVD) mortality in individuals with an alerting reaction, assessed by hypertension in the first blood pressure (BP) reading but normal BP in further readings, remains unknown in the general population. METHODS AND RESULTS In a sample of 11 146 adults (51.5% men and 48.5% women) with a mean age of 47.1 years (SD ± 12.3) from a German population-based cohort, we analyzed risk factors and CVD mortality risk associated with an alerting reaction. An alerting reaction was prevalent in 10.2% of the population and associated with sociodemographic, lifestyle, and somatic CVD risk factors. Within a mean follow-up period of 22.7 years (SD ± 7.05 years; max: 32 years; 253 201 person years), 1420 (12.7%) CVD mortality cases were observed. The CVD mortality rate associated with an alerting reaction was significantly higher than in normotension (64 vs. 32 cases/10 000 person-years), but lower than hypertension (118 cases/10 000 person-years). Correspondingly, the alerting reaction was associated with a 23% higher hazard ratio of CVD mortality than normal blood pressure [hazard ratio 1.23 (95% confidence interval 1.02-1.49), P = 0.04]. However, adjustment for antihypertensive medication use attenuated this association [1.19 (0.99-1.44), P = 0.06]. CONCLUSION The results may warrant monitoring of an alerting reaction as a preventive measure of CVD mortality in untreated individuals with elevated first BP readings, as well as optimized treatment in treated individuals.
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Affiliation(s)
- Seryan Atasoy
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University of Giessen and Marburg, Germany
| | - Peter Henningsen
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Hamimatunnisa Johar
- Department of Psychosomatic Medicine and Psychotherapy, University of Giessen and Marburg, Germany
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Martin Middeke
- Hypertension Center Munich, a European Society of Hypertension (ESH) Center of Excellence, Munich, Germany
| | - Heribert Sattel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Birgit Linkohr
- Institute of Epidemiology, Helmholtz Zentrum Munich - German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Partnersite Munich
| | - Ina-Maria Rückert-Eheberg
- Institute of Epidemiology, Helmholtz Zentrum Munich - German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Margit Heier
- Institute of Epidemiology, Helmholtz Zentrum Munich - German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- Kora Study Centre, University Hospital of Augsburg, Augsburg, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum Munich - German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Partnersite Munich
- Chair of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Karl-Heinz Ladwig
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Partnersite Munich
- Hypertension Center Munich, a European Society of Hypertension (ESH) Center of Excellence
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Inter-arm systolic blood pressure difference: non-persistence and association with incident cardiovascular disease in the Multi-ethnic Study of Atherosclerosis. J Hum Hypertens 2023; 37:197-204. [PMID: 35296776 PMCID: PMC9477971 DOI: 10.1038/s41371-022-00669-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/08/2022] [Accepted: 02/23/2022] [Indexed: 11/09/2022]
Abstract
We investigated inter-arm systolic blood pressure (sIAD) difference, reproducibility, and incident cardiovascular disease (CVD). We hypothesized that higher sIAD values have low prevalence and nonpersistence over years, but that CVD risk is higher starting from the time of first high absolute sIAD. In Multi-Ethnic Study of Atherosclerosis participants (n = 6725, 53% female, 45-84 years old), Doppler systolic blood pressure (SBP) measurements were made in both arms (10-minute interval) thrice over 9.5 years. Proportional hazards for CVD (coronary heart disease, heart failure, stroke, peripheral arterial disease (PAD)) over 16.4 years were tested according to time-varying absolute inter-arm difference with covariates: (1) age, gender, race, and clinic; (2) model 1 plus height, heart rate, BP, antihypertensives, BMI, smoking status, lipids, lipid lowering medication, and diabetes. High sIAD was not persistent across exams. Maximum absolute sIAD ≥ 15 mmHg was found at least once in 815 persons. Maximum absolute sIAD had a graded relationship with incident stroke or PAD: 6.2% events; model 2 hazard ratio per 10 mmHg 1.34 (95% CI, 1.15-1.56) and this risk was approximately doubled for maximum absolute sIAD ≥ 15 mmHg vs 0-4 mmHg. Total CVD risk (18.4% events) was increased only for maximum absolute sIAD ≥25 mmHg. Associations with incident CVD did not differ for higher SBP in left vs right arm. A higher maximum absolute sIAD at any exam was associated with greater risk for stroke and PAD especially for values ≥ 15 mmHg, and ≥25 mmHg for other CVD. Measuring SBP between arms may help identify individuals at risk for CVD.
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Zarife AS, Fraga-Maia H, Mill JG, Lotufo P, Griep RH, Fonseca MDJMD, Brito LL, Almeida MDC, Aras R, Matos SMA. Variabilidade da Pressão Arterial em Única Visita e Risco Cardiovascular em Participantes do ELSA-Brasil. Arq Bras Cardiol 2022; 119:505-511. [PMID: 36074482 PMCID: PMC9563895 DOI: 10.36660/abc.20210804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 04/06/2022] [Indexed: 11/18/2022] Open
Abstract
Fundamento A variabilidade da pressão arterial (VPA) tem valor prognóstico para desfechos cardiovasculares fatais e não fatais. Objetivos Este estudo teve como objetivo avaliar a associação entre a VPA em uma única visita e o risco cardiovascular em participantes do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). Métodos O presente estudo transversal foi conduzido com dados basais (2008-2010) de 14.357 participantes do ELSA-Brasil, sem história de doença cardiovascular. A VPA foi quantificada pelo coeficiente de variação de três medidas padronizadas da pressão arterial sistólica (PAS) realizadas com um oscilômetro. Medidas antropométricas e exames laboratoriais também foram realizados. O risco cardiovascular foi avaliado pelo estimador de risco de doença cardiovascular aterosclerótica (ASCVD), e se empregou a análise de regressão logística multivariada com nível de significância de 5%. Resultados Um risco cardiovascular significativamente maior foi determinado por uma VPA elevada para ambos os sexos. Uma prevalência significativamente maior de alto risco foi observada mais em homens que em mulheres em todos os quartis, com a maior diferença observada no quarto quartil de variabilidade (48,3% vs. 17,1%). Comparações entre quartis por sexo revelaram um risco significativamente mais alto para homens no terceiro (OR=1,20; IC95%: 1,02 - 1,40) e no quarto quartis OR=1,46; IC95%: 1,25 -1,71), e para mulheres no quarto quartil (OR=1,27; IC95%: 1,03 - 1,57). Conclusão Análises de dados basais de participantes do ELSA-Brasil revelaram que a variabilidade da pressão arterial se associou com risco cardiovascular aumentado, especialmente nos homens.
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Predictive value of within-visit and visit-to-visit blood pressure variability for all-cause mortality: the Minhang Study. J Hypertens 2021; 39:1844-1851. [PMID: 34001813 DOI: 10.1097/hjh.0000000000002867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Blood pressure variability is a common physiological phenomenon; however, the association between within-visit and visit-to-visit variability in blood pressure and all-cause mortality remains uncertain. METHODS We conducted a retrospective analysis of blood pressure variability among 11 721 adults who underwent blood pressure measurement on three occasions within a period of 6 months. Within-visit and visit-to-visit variability was quantified using the standard deviation and maximum--minimum difference between measures. The predictive effect of this variability on all-cause mortality was evaluated using Kaplan--Meier survival curves and Cox regression analysis. RESULTS The incidence of all-cause mortality was significantly higher for participants in the top quintile of within-visit and visit-to-visit blood pressure variability and for those with sustained high within-visit variability. Within-visit variability was not retained as a risk factor after adjustment in Cox regression models. The hazard ratio for mortality increased from 48 to 55% for the top quintile of visit-to-visit blood pressure variability and from 56 to 61% for sustained high within-visit variability. The risk of mortality remained statistically higher even if visit-to-visit blood pressure variability was added to the model, including consistency of within-visit blood pressure variability and vice versa. CONCLUSION Visit-to-visit and sustained high within-visit blood pressure variability were significant positive prognostic factors for all-cause mortality. Our findings underlined the clinical significance of achieving stable blood pressure in an effective plan of hypertension management.
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Within-visit and between-visit intra-individual blood pressure variability in an unselected adult population from rural China. J Hypertens 2021; 39:1346-1351. [PMID: 33967241 DOI: 10.1097/hjh.0000000000002810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the association between the variability of blood pressure (BP) readings within an initial clinic visit, the variability within subsequent visits and the variability between visits over 1 week in a general population. METHODS This study included 1401 adult residents, who were not taking antihypertensive drugs, having BP measurements at three visits over 1 week. The difference between maximal and minimal BP readings (ΔBP), ΔBP/BPm (the mean BP value in a visit), the standard deviation (SD) and coefficient of variation (coefficient of variation = SD × 100/mean) of three BP values in each visit were used to estimate the within-visit BP variability (BPV). The SD and coefficient of variation of all nine BP readings over the three visits were calculated as SD9 or CV9 to reflect the overall BPV during the study visits. The SD and coefficient of variation on the mean BP values (BPm) of three visits were computed as SD-3 or CV-3, whereas the difference between maximal and minimal BP in three visits was computed as ΔBP-3 to estimate visit-to-visit BPV. The average BP or HR was the mean values of nine BP or HR readings over three visits. RESULTS The systolic and diastolic mean BP (SBP and DBP) decreased from the first to the third visit. The ΔBP, SD and coefficient of variation for both SBP and DBP at the first visit were positively and significantly correlated with the corresponding variables computed at the second and third visits, as well as with overall BPV (ΔBP9, SD9 and CV9). A positive correlation was also found between overall BPV and visit-to visit BPV (SD-3, CV-3 and ΔBP9). Multivariate analysis showed: no association between average SBP and systolic coefficient of variation or ΔBP/BPm but a negative association between average DBP and coefficient of variation or ΔBP/BPm for DBP at the first visit, DBP-3 and DBP9. Age was positively correlated with coefficient of variation or ΔBP/BPm for SBP at the first visit, SBP-3 and SBP9, and correlated with coefficient of variation and ΔBP/BPm for DBP only at the first visit. CONCLUSION In a general population, within-visit BPV at an initial visit is associated with within-visit BPV at subsequent visits and with visit-to-visit BPV over three visits within 1 week.
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Within-visit SBP variability from childhood to adulthood and markers of cardiovascular end-organ damage in mid-life. J Hypertens 2021; 39:1865-1875. [PMID: 34397629 DOI: 10.1097/hjh.0000000000002855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Within-visit SBP variability is associated with age and SBP, but its long-term clinical significance is unknown. We examined the association between child, adult, and life-time within-visit SBP variability with markers of end-organ damage using data from a 31-year longitudinal study. METHODS Within-visit SBP variability was calculated as the standard deviation of three sitting SBP readings among up to 3010 participants aged 6-18 years (childhood) who were re-measured up to seven times to mid-adulthood. Markers of cardiovascular end-organ damage in adulthood were carotid intima--media thickness, brachial flow-mediated dilatation, carotid distensibility, pulse wave velocity, left ventricular mass index, carotid plaque, and coronary artery calcification. RESULTS The mean (standard deviation) cumulative within-visit SBP variability was 2.7 (1.5) mmHg in childhood, 3.9 (1.9) mmHg in adulthood and 3.7 (1.5) mmHg across the observed life-time. Childhood within-visit SBP variability was not correlated with its subsequent values measured from 3 to 31 years later. With adjustment for age, sex, cumulative SBP, BMI and serum lipids, neither child, adult, or life-time cumulative within-visit SBP variability associated with markers of cardiovascular end-organ damage. However, higher child, adult, and life-time cumulative SBP significantly associated with higher carotid intima--media thickness, higher pulse wave velocity, lower brachial flow-mediated dilatation, lower carotid distensibility in adulthood. CONCLUSION Within-visit SBP variability from childhood to adulthood does not provide additional predictive utility over SBP over the same period of the life course.
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Relation between Blood Pressure Variability within a Single Visit and Stroke. Int J Hypertens 2021; 2021:2920140. [PMID: 33747558 PMCID: PMC7943313 DOI: 10.1155/2021/2920140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 10/18/2020] [Accepted: 02/05/2021] [Indexed: 12/04/2022] Open
Abstract
Blood pressure variability (BPV) has been identified as an important risk factor for cardiovascular events. The white coat effect (WCE), which is measured as the first systolic blood pressure (SBP) measurement minus the mean of the second and third measurements, is a BPV indicator within a single visit. In total, 2,972 participants who had three measurements of BP within a single visit were included. The participants were divided into three groups based on their WCE percentiles: Group 1 (WCE2.5-97.5, 2.5–97.5th percentiles of WCE), Group 2 (WCE2.5, 0–2.4th percentiles of WCE), and Group 3 (WCE97.5, 97.6–100th percentiles of WCE). A multiple logistic regression model was used to analyze the relationship between WCE and stroke after adjusting for cardiovascular disease risk factors. Compared with the WCE2.5-97.5 group, the OR for stroke in the WCE2.5 group was 2.78 (95% CI: 1.22, 6.36, p=0.015). After adjusting for cardiovascular factors, OR increased to 3.12 (95% CI: 1.22, 7.96, p=0.017). The OR of WCE for stroke was 0.93 (95%CI: 0.87, 0.99, p=0.036). BPV within a single visit is associated with stroke. The value and direction of the change may be important as well.
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A cohort-based comprehensive characterization of different patterns of very short-term, within-visit, blood pressure variability. Blood Press Monit 2020; 25:131-135. [PMID: 32106147 DOI: 10.1097/mbp.0000000000000435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIM To characterize different patterns of variability of three repeated within-visit blood pressure (BP) readings and to determine the prevalence of specific variation trends in systolic (SBP), diastolic (DBP) blood pressure and pulse pressure (PP). METHODS Data from 53 737 subjects from the National Health and Nutrition Examination Survey were analyzed. In each subject, three consecutive BP measurements were performed with a minimum time-interval of at least 30 s. We propose three patterns of within-visit BP variability (separately for SBP, DBP and PP): (1) increasing trend (BP3 > BP2 > BP1); (2) decreasing trend (BP1 > BP2 > BP3) and (3) no trend (BP3 ≈ BP2 ≈ BP1). A threshold of minimum change (ΔP > 3 mmHg) between BP1-BP2 and BP2-BP3 was also applied as a prerequisite for the definition of these trends. RESULTS An increasing trend was observed among three consecutive measurements of SBP, DBP and PP in 7.4, 10.4 and 10.2%, respectively. When a minimum threshold of 3 mmHg was set the respective increasing trends were observed in 1.8, 2.9 and 4.4%, respectively. There was a higher prevalence of decreasing trend within three consecutive SBP, DBP and PP readings: 17, 13.1 and 16.2%, respectively, whereas using a threshold of ΔP >3 mmHg the respective prevalence was 6.3, 4.1 and 7.7%. A maximum absolute difference >10 mmHg within triplicate of SBP/DBP/PP readings was observed in 12.9, 13 and 29.4%, respectively. In the era of personalized medicine, these patterns are well worth further investigation concerning their pathophysiologic and clinical relevance.
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Mehlum MH, Liestøl K, Kjeldsen SE, Wyller TB, Julius S, Rothwell PM, Mancia G, Parati G, Weber MA, Berge E. Blood Pressure–Lowering Profiles and Clinical Effects of Angiotensin Receptor Blockers Versus Calcium Channel Blockers. Hypertension 2020; 75:1584-1592. [DOI: 10.1161/hypertensionaha.119.14443] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Blood pressure–lowering drugs have different blood pressure–lowering profiles. We studied if differences in blood pressure mean and variability can explain the differences in risks of cardiovascular events and death among 15 245 high-risk hypertensive patients randomized to valsartan or amlodipine and followed for 4.2 years in the VALUE trial (Valsartan Antihypertensive Long-Term Use Evaluation). We selected patients with ≥3 visits and performed Cox regression analyses, defining mean blood pressure as a time-dependent covariate and visit-to-visit and within-visit blood pressure variability as the SD. Of 14 996 eligible patients, participants in the valsartan group had higher systolic mean blood pressure by 2.2 mm Hg, higher visit-to-visit systolic variability by 1.4 mm Hg, and higher within-visit systolic variability by 0.2 mm Hg (
P
values <0.0001). The higher risks of myocardial infarction and stroke in the valsartan group was attenuated after adjustment for mean and variability of systolic blood pressure, from HR 1.19 (95% CI, 1.02–1.39) to 1.11 (0.96–1.30) and from HR 1.13 (0.96–1.33) to 1.00 (0.85–1.18), respectively. The lower risk of congestive heart failure in the valsartan group was accentuated after adjustment, from HR 0.86 (0.74–1.00) to 0.76 (0.65–0.89). A smaller effect was seen on risk of death, from 1.01 (0.92–1.12) to 0.94 (0.85–1.04). In conclusion, the higher risks of myocardial infarction and stroke in patients randomized to valsartan versus amlodipine were related to the drugs’ different blood pressure modulating profiles. The risk of congestive heart failure with valsartan was lower, independent of the less favorable blood pressure modulating profile.
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Affiliation(s)
- Maria H. Mehlum
- From the Department of Geriatric Medicine (M.H.M., T.B.W.), Oslo University Hospital Ullevaal, Oslo, Norway
- Institute of Clinical Medicine (M.H.M., S.E.K., T.B.W.), University of Oslo, Norway
| | - Knut Liestøl
- Department of Informatics (K.L.), University of Oslo, Norway
| | - Sverre E. Kjeldsen
- Department of Cardiology (S.E.K., E.B.), Oslo University Hospital Ullevaal, Oslo, Norway
- Institute of Clinical Medicine (M.H.M., S.E.K., T.B.W.), University of Oslo, Norway
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (S.E.K., S.J.)
| | - Torgeir B. Wyller
- From the Department of Geriatric Medicine (M.H.M., T.B.W.), Oslo University Hospital Ullevaal, Oslo, Norway
- Institute of Clinical Medicine (M.H.M., S.E.K., T.B.W.), University of Oslo, Norway
| | - Stevo Julius
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (S.E.K., S.J.)
| | - Peter M. Rothwell
- Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, John Radcliffe Hospital, University of Oxford, United Kingdom (P.M.R.)
| | - Giuseppe Mancia
- Policlinico di Monza, Monza, Italy (G.M.)
- University of Milano-Bicocca, Milan, Italy (G.M., G.P.)
| | - Gianfranco Parati
- University of Milano-Bicocca, Milan, Italy (G.M., G.P.)
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, Milan, Italy (G.P.)
| | - Michael A. Weber
- Department of Cardiovascular Medicine, State University of New York, Downstate College of Medicine (M.A.W.)
| | - Eivind Berge
- Department of Cardiology (S.E.K., E.B.), Oslo University Hospital Ullevaal, Oslo, Norway
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Muntner P, Shimbo D, Carey RM, Charleston JB, Gaillard T, Misra S, Myers MG, Ogedegbe G, Schwartz JE, Townsend RR, Urbina EM, Viera AJ, White WB, Wright JT. Measurement of Blood Pressure in Humans: A Scientific Statement From the American Heart Association. Hypertension 2019; 73:e35-e66. [PMID: 30827125 DOI: 10.1161/hyp.0000000000000087] [Citation(s) in RCA: 652] [Impact Index Per Article: 130.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The accurate measurement of blood pressure (BP) is essential for the diagnosis and management of hypertension. This article provides an updated American Heart Association scientific statement on BP measurement in humans. In the office setting, many oscillometric devices have been validated that allow accurate BP measurement while reducing human errors associated with the auscultatory approach. Fully automated oscillometric devices capable of taking multiple readings even without an observer being present may provide a more accurate measurement of BP than auscultation. Studies have shown substantial differences in BP when measured outside versus in the office setting. Ambulatory BP monitoring is considered the reference standard for out-of-office BP assessment, with home BP monitoring being an alternative when ambulatory BP monitoring is not available or tolerated. Compared with their counterparts with sustained normotension (ie, nonhypertensive BP levels in and outside the office setting), it is unclear whether adults with white-coat hypertension (ie, hypertensive BP levels in the office but not outside the office) have increased cardiovascular disease risk, whereas those with masked hypertension (ie, hypertensive BP levels outside the office but not in the office) are at substantially increased risk. In addition, high nighttime BP on ambulatory BP monitoring is associated with increased cardiovascular disease risk. Both oscillometric and auscultatory methods are considered acceptable for measuring BP in children and adolescents. Regardless of the method used to measure BP, initial and ongoing training of technicians and healthcare providers and the use of validated and calibrated devices are critical for obtaining accurate BP measurements.
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Rodrigues AB, Gismondi RA, Lagoeiro A, Cecilio AM, Vasques D, Arita R, Folegatti T, Rosa ML. Association between B-type natriuretic peptide and within-visit blood pressure variability. Clin Cardiol 2018; 41:778-781. [PMID: 29604077 DOI: 10.1002/clc.22953] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 03/18/2018] [Accepted: 03/27/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Blood pressure variability (BPV) has been shown to predict cardiovascular events. Within-visit BPV is the simplest and easiest measure of BPV, but previous studies have shown conflicts as to whether within-visit BPV correlates with target organ damage. We aimed to evaluate whether within-visit BPV correlates with B-type natriuretic peptide (BNP) in a general population. HYPOTHESIS Within-visit BPV correlates with BNP in a general population. METHODS This was a cross-sectional study that included 633 individuals, randomly selected, age 45 to 99 years, registered in the primary care program from an urban medium-sized town. Patients were scheduled for a single-day visit that consisted of clinical evaluation and laboratory tests. Three blood pressure (BP) readings, 1 minute apart, were done, and within-visit BPV was determined as the coefficient of variation (CV) of the 3 BP measures. Our main outcome was to correlate BNP and within-visit BPV. A multivariable model was estimated using a generalized linear model to evaluate the independent effects of different variables on BNP levels. RESULTS The median age was 57 years. Median BNP was 16 pg/mL, and the median systolic and diastolic BP-CV were, respectively, 3.9% and 3.5%. There was a weak but positive correlation between BNP and both systolic BP-CV and diastolic BP-CV (r = 0.107 and P = 0.007 and r = 0.092 and P = 0.019, respectively). In multiple regression equation, systolic BP, diastolic BP-CV, body mass index, and estimated glomerular filtration rate were associated with BNP. CONCLUSIONS In the present study, there was a positive, albeit weak, correlation between within-visit BPV and BNP. In addition, diastolic BPV was associated with BNP even after adjustment for multiple confounders.
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Affiliation(s)
- Ana Beatriz Rodrigues
- Department of Epidemiology and Statistics, Institute of Public Health, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Ronaldo Altenburg Gismondi
- Department of Clinical Medicine, Antonio Pedro University Hospital, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Antonio Lagoeiro
- Department of Clinical Medicine, Antonio Pedro University Hospital, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Angela Mendes Cecilio
- Department of Clinical Medicine, Antonio Pedro University Hospital, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Delvo Vasques
- Department of Clinical Medicine, Antonio Pedro University Hospital, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Rafael Arita
- Department of Clinical Medicine, Antonio Pedro University Hospital, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Thabata Folegatti
- Department of Clinical Medicine, Antonio Pedro University Hospital, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Maria Luiza Rosa
- Department of Epidemiology and Statistics, Institute of Public Health, Fluminense Federal University, Rio de Janeiro, Brazil
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Abellán-Huerta J, Prieto-Valiente L, Montoro-García S, Abellán-Alemán J, Soria-Arcos F. Correlation of Blood Pressure Variability as Measured By Clinic, Self-measurement at Home, and Ambulatory Blood Pressure Monitoring. Am J Hypertens 2018; 31:305-312. [PMID: 29040398 DOI: 10.1093/ajh/hpx183] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 10/05/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Blood pressure variability (BPV) has been postulated as a potential predictor of cardiovascular outcomes. No agreement exists as to which measurement method is best for BPV estimation. We attempt to assess the correlation between BPV obtained at the doctor's office, self-measurement at home (SMBP) and ambulatory BP monitoring (ABPM). METHODS Eight weekly clinic BP measurements, 2 SMBP series, and 1 24-hour ABPM recording were carried out in a sample of treated hypertensive patients. BPV was calculated using the SD, the "coefficient of variation" and the "average real variability." Determinants of short-, mid-, and long-term BPV (within each measurement method) were also calculated. The different BPV determinants were correlated "intramethod" and "intermethod" by linear regression test. RESULTS For the 104 patients (66.5 ± 7.7 years, 58.7% males), the ABPM BPV (SD, systolic/diastolic: 14.5 ± 3.1/9.8 ± 2.5 mm Hg) was higher than the SMBP (12.2 ± 9.8/7.4 ± 5.8 mm Hg; P < 0.001) and clinic BPV (10 ± 8.9/5.9 ± 4.9 mm Hg; P = 0.001). The main BPV correlation between methods was weak, with a maximum R2 = 0.17 (P < 0.001) between clinic and SMBP systolic BPV. The "intramethod" correlation of BPV yielded a maximum R2 = 0.21 (P < 0.001) between morning diastolic SMBP intershift/intermeans variability. The "intermethod" correlation of short-, mid-, and long-term BPV determinants was weak (maximum R2 = 0.22, P < 0.001, between clinic intraday variability/SMBP morning intershift variability). CONCLUSIONS The "intramethod" and "intermethod" correlation between BPV determinants was weak or nonexistent, even when comparing determinants reflecting the same type of temporal BPV. Our data suggest that BPV reflects a heterogeneous phenomenon that strongly depends on the estimation method and the time period evaluated.
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Affiliation(s)
- José Abellán-Huerta
- Cardiology Department, Hospital General Universitario Santa Lucía, Cartagena, Spain
| | | | | | | | - Federico Soria-Arcos
- Cardiology Department, Hospital General Universitario Santa Lucía, Cartagena, Spain
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Azushima K, Wakui H, Uneda K, Haku S, Kobayashi R, Ohki K, Kinguchi S, Haruhara K, Fujikawa T, Toya Y, Umemura S, Tamura K. Within-visit blood pressure variability and cardiovascular risk factors in hypertensive patients with non-dialysis chronic kidney disease. Clin Exp Hypertens 2017. [DOI: 10.1080/10641963.2017.1313850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Kengo Azushima
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- Cardiovascular and Metabolic Disorders Program, Duke-NUS Medical School, Singapore
| | - Hiromichi Wakui
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kazushi Uneda
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Sona Haku
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Ryu Kobayashi
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kohji Ohki
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Sho Kinguchi
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kotaro Haruhara
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Tetsuya Fujikawa
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yoshiyuki Toya
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Satoshi Umemura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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14
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Yano Y, Vongpatanasin W, Ayers C, Turer A, Chandra A, Carnethon MR, Greenland P, de Lemos JA, Neeland IJ. Regional Fat Distribution and Blood Pressure Level and Variability: The Dallas Heart Study. Hypertension 2016; 68:576-83. [PMID: 27432862 DOI: 10.1161/hypertensionaha.116.07876] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 06/22/2016] [Indexed: 01/24/2023]
Abstract
Our aim was to investigate the associations of regional fat distribution with home and office blood pressure (BP) levels and variability. Participants in the Dallas Heart Study, a multiethnic cohort, underwent 5 BP measurements on 3 occasions during 5 months (2 in home and 1 in office) and quantification of visceral adipose tissue, abdominal subcutaneous adipose tissue, and liver fat by magnetic resonance imaging, and lower body subcutaneous fat by dual x-ray absorptiometry. The relation of regional adiposity with short-term (within-visit) and long-term (overall visits) mean BP and average real variability was assessed with multivariable linear regression. We have included 2595 participants with a mean age of 44 years (54% women; 48% black), and mean body mass index was 29 kg/m(2) Mean systolic BP/diastolic BP was 127/79 mm Hg and average real variability systolic BP was 9.8 mm Hg during 3 visits. In multivariable-adjusted models, higher amount of visceral adipose tissue was associated with higher short-term (both home and office) and long-term mean systolic BP (β[SE]: 1.9[0.5], 2.7[0.5], and 2.1[0.5], respectively; all P<0.001) and with lower long-term average real variability systolic BP (β[SE]: -0.5[0.2]; P<0.05). In contrast, lower body fat was associated with lower short-term home and long-term mean BP (β[SE]: -0.30[0.13] and -0.24[0.1], respectively; both P<0.05). Neither subcutaneous adipose tissue or liver fat was associated with BP levels or variability. In conclusion, excess visceral fat was associated with persistently higher short- and long-term mean BP levels and with lower long-term BP variability, whereas lower body fat was associated with lower short- and long-term mean BP. Persistently elevated BP, coupled with lower variability, may partially explain increased risk for cardiac hypertrophy and failure related to visceral adiposity.
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Affiliation(s)
- Yuichiro Yano
- From the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., M.R.C., P.G.); Cardiology Division, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (W.V., A.T., A.C., J.A.d.L., I.J.N.); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas (C.A.)
| | - Wanpen Vongpatanasin
- From the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., M.R.C., P.G.); Cardiology Division, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (W.V., A.T., A.C., J.A.d.L., I.J.N.); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas (C.A.)
| | - Colby Ayers
- From the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., M.R.C., P.G.); Cardiology Division, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (W.V., A.T., A.C., J.A.d.L., I.J.N.); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas (C.A.)
| | - Aslan Turer
- From the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., M.R.C., P.G.); Cardiology Division, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (W.V., A.T., A.C., J.A.d.L., I.J.N.); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas (C.A.)
| | - Alvin Chandra
- From the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., M.R.C., P.G.); Cardiology Division, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (W.V., A.T., A.C., J.A.d.L., I.J.N.); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas (C.A.)
| | - Mercedes R Carnethon
- From the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., M.R.C., P.G.); Cardiology Division, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (W.V., A.T., A.C., J.A.d.L., I.J.N.); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas (C.A.)
| | - Philip Greenland
- From the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., M.R.C., P.G.); Cardiology Division, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (W.V., A.T., A.C., J.A.d.L., I.J.N.); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas (C.A.)
| | - James A de Lemos
- From the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., M.R.C., P.G.); Cardiology Division, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (W.V., A.T., A.C., J.A.d.L., I.J.N.); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas (C.A.)
| | - Ian J Neeland
- From the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., M.R.C., P.G.); Cardiology Division, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (W.V., A.T., A.C., J.A.d.L., I.J.N.); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas (C.A.).
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Shibasaki S, Hoshide S, Kario K. Within-Home Blood Pressure Variability on a Single Occasion Has Clinical Significance. Pulse (Basel) 2016; 4:38-42. [PMID: 27493902 DOI: 10.1159/000445837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
There is growing evidence that diversely defined blood pressure variability (BPV) is an independent predictor of hypertensive target organ damage (TOD) and cardiovascular events. Several mechanisms have been speculated to underlie episodes of increased BPV, including the impairment of autonomic or hormonal regulation, renal dysfunction, and increased arterial stiffness. Within-home BPV, defined as differences in BP values obtained on a single occasion at home, could have prognostic significance for hypertensive TOD. It is typically thought that BP values are decreased with repeated measurements on a single occasion at home, but in the present subanalysis of 4,149 J-HOP (Japan Morning Surge-Home Blood Pressure) study patients, approximately 20% of the patients' home BP values were increased or unchanged by repeated measurements on a single occasion. In addition, those patients were likely to have hypertensive TOD. Thus, home BP measurement should be taken twice or more to detect the increase trend in home BP, which has been defined as within-home BPV.
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Affiliation(s)
- Seiichi Shibasaki
- Department of General Internal Medicine, Saiseikai Yamaguchi General Hospital, Yamaguchi, Japan; Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
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16
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Within-visit BP variability, cardiovascular risk factors, and BP control in central and eastern Europe. J Hypertens 2015; 33:2250-6. [DOI: 10.1097/hjh.0000000000000700] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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17
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Target organ complications and prognostic significance of alerting reaction: analysis from the Dallas Heart Study. J Hypertens 2015; 34:226-34. [PMID: 26485459 DOI: 10.1097/hjh.0000000000000774] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Noninvasive blood pressure (BP) measurement often triggers a transient rise in BP, known as an alerting reaction. However, the prevalence and prognostic significance of the alerting reaction has never been assessed in the general population. METHODS We evaluated the association between the alerting reaction and left ventricular mass by MRI and urinary albumin-to-creatinine ratio in the Dallas Heart Study, a large population sample of 3069 individuals. Participants were categorized into four groups based on levels of consecutive BP: first, normal first BP and average third to fifth (avg3-5) BP of less than 140/90 mmHg (control group); second, high first BP of at least 140/90 mmHg and normal (avg3-5) BP (alerting reaction group); third, normal first BP and high (avg3-5) BP; and fourth, high first to fifth BP. Then, associations between BP categories with incident cardiovascular outcomes (coronary heart disease, stroke, atrial fibrillation, heart failure, and cardiovascular death) over a median follow-up period of 9.4 years were assessed. RESULTS The sample-weighted prevalence of isolated hypertension during the first BP measurement was 9.6%. Presence of an alerting reaction was independently associated with increased left ventricular mass, urinary albumin-to-creatinine ratio, cardiovascular events after adjustment for traditional cardiovascular risk factors, and baseline BP (adjusted hazard ratio 1.24, 95% confidence interval 1.07-1.43). CONCLUSION Our study indicated that the alerting reaction is independently associated with increased cardiovascular and renal complications.
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18
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Pannier B, Thomas F, Hanon O, Czernichow S, Lemogne C, Simon T, Simon JM, Danchin N. Individual 6-year systolic blood pressure change and impact on cardiovascular mortality in a French general population. J Hum Hypertens 2015; 30:18-23. [PMID: 26016599 DOI: 10.1038/jhh.2015.44] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 03/09/2015] [Accepted: 04/09/2015] [Indexed: 11/09/2022]
Abstract
Impact of blood pressure (BP) visit-to-visit variability remains controversial for untreated hypertensives and for normotensive subjects. Association between 6-year systolic BP change and all-cause and cardiovascular (CVD) mortality was studied in general primary care population including untreated hypertensive and normotensive subjects. Normotensive individuals and untreated high BP patients (40,926 and 14,283, respectively) had two check-ups (interval: 5.8±2.2 years) at the IPC center (Paris). Follow-up was 6.1±3.2 years: 1131 people died, 114 from CVD causes. Systolic BP (SBP) change was assessed by tertiles of absolute differences between V1 and V2, and the relationship with mortality was analysed with multivariate Cox models (hazard ratio (HR), 95% confidence interval (CI)) including V1 or V2 parameters notably SBP. Adjusting for V1 variables, mortality was associated with SBP change, for the entire population (all-cause: HR=1.15 (95%: 1.01-1.30) and CVD: HR=1.95 (95%: 1.25-3.05)) and in hypertensive individuals: (HR=1.31 (95%: 1.08-1.59) and HR=2.51 (95%: 1.34-4.72), respectively). Adjustments for V2 variables gave similar results. For those who were normotensive at V1, the associations were not significant. In this primary care population, individual long-term visit-to-visit change of BP is an independent predictor of all-cause mortality in hypertensive individuals but not in those with normal BP.
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Affiliation(s)
- B Pannier
- Centre IPC, Paris, France.,Hopital Manhès, Fleury-Merogis, France
| | | | - O Hanon
- Centre IPC, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, Paris, France.,Hopital Broca, APHP, Paris, France
| | - S Czernichow
- Hopital Ambroise Paré, APHP, Université Paris Ile de France Ouest, Boulogne, France
| | - C Lemogne
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, Paris, France.,Hôpitaux Universitaires Paris Ouest, APHP, Paris, France.,Inserm U894, Centre Psychiatrie et Neurosciences, Paris, France
| | - T Simon
- Hopital Saint Antoine, APHP, Université Pierre et Marie Curie, Paris, France
| | - J-M Simon
- Hopital Pitié Salpétrière, APHP, Paris, France
| | - N Danchin
- Centre IPC, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, Paris, France.,Hôpitaux Universitaires Paris Ouest, APHP, Paris, France
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19
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Okada R, Yasuda Y, Tsushita K, Wakai K, Hamajima N, Matsuo S. Within-visit blood pressure variability is associated with prediabetes and diabetes. Sci Rep 2015; 5:7964. [PMID: 25589061 PMCID: PMC4295087 DOI: 10.1038/srep07964] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 01/02/2015] [Indexed: 12/21/2022] Open
Abstract
We investigated the associations between within-visit blood pressure variability (BPV) and risk factors for cardiovascular disease (CVD). The study subjects included 17,795 people aged 40–74 years who underwent health check-ups in Aichi Prefecture, Japan, and completed two blood pressure measurements. Subjects were categorized into three groups according to the difference of systolic blood pressure (ΔSBP), namely, low-BPV (≤10 mmHg), moderate-BPV (11–20 mmHg), and high-BPV (>20 mmHg). Subjects were also divided into three categories as those without prediabetes (glycosylated hemoglobin A1c [HbA1c] < 5.7%), prediabetes (HbA1c 5.7–6.4%) and diabetes (HbA1c ≥ 6.5% or under treatment for diabetes). The proportion of prediabetes and diabetes were significantly higher in subjects with high-BPV than in those with low-BPV after adjusting for age, sex, and mean SBP (odds ratio [95% confidence interval] was 1.16 [1.01–1.33] for prediabetes and 1.33 [1.06–1.66] for diabetes). Other CVD risk factors were not associated with high-BPV after the adjustment. In conclusion, increased within-visit BPV was significantly associated with the prevalence of prediabetes and diabetes, independent of mean SBP, in a large general population. Therefore, assessing BPV in a single visit may help to identify subjects at increased risk of impaired glycemic control.
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Affiliation(s)
- Rieko Okada
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshinari Yasuda
- Department of Nephrology, Internal Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuyo Tsushita
- Comprehensive Health Science Center, Aichi Health Promotion Foundation, Aichi, Japan
| | - Kenji Wakai
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuyuki Hamajima
- Department of Young Leaders' Program in Health Care Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Seiichi Matsuo
- Department of Nephrology, Internal Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
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20
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Salazar MR, Espeche WG, Aizpurúa M, Sisnieguez CEL, Sisnieguez BCL, Dulbecco CA, March CE, Stavile RN, Ferrari EH, Correa M, Maciel PM, Balbín E, Carbajal HA. Should the first blood pressure reading be discarded? J Hum Hypertens 2014; 29:373-8. [PMID: 25339293 DOI: 10.1038/jhh.2014.98] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 08/24/2014] [Accepted: 09/18/2014] [Indexed: 11/09/2022]
Abstract
We evaluated the consequences of excluding the first of three blood pressure (BP) readings in different settings: a random population sample (POS, n=1525), a general practice office (GPO, n=942) and a specialized hypertension center (SHC, n=462). Differences between systolic and diastolic BP (SBP and DBP) estimates obtained including and excluding the first reading were compared and their correlation with ambulatory BP monitoring (ABPM) was estimated. The samples were divided into quartiles according to the difference between the third and the first SBP (3-1ΔSBP). SBP decreased through sequential readings, 3-1ΔSBP was -5.5 ± 9.7 mm Hg (P<0.001), -5.1 ± 10.4 mm Hg (P<0.001) and -6.1 ± 9.3 mm Hg (P<0.001) for POS, GPO and SHC, respectively. However, individuals included in the top quartile of 3-1ΔSBP showed their highest values on the third reading. The mean SBP estimate was significantly higher excluding the first reading (P<0.001), but the differences among both approaches were small (1.5-1.6 mm g). Moreover, the correlation between SBP values including and excluding the first reading and daytime ABPM were comparable (r = 0.69 and 0.68, respectively). Similar results were observed for DBP. In conclusion, our study does not support the notion of discarding the first BP measurement and suggests that it should be measured repeatedly, regardless the first value.
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Affiliation(s)
- M R Salazar
- 1] Clinica Medica, Hospital San Martín, La Plata, Buenos Aires, Argentina [2] Facultad de Ciencias Médicas, Universidad Nacional de La Plata, La Plata, Argentina
| | - W G Espeche
- 1] Clinica Medica, Hospital San Martín, La Plata, Buenos Aires, Argentina [2] Facultad de Ciencias Médicas, Universidad Nacional de La Plata, La Plata, Argentina
| | - M Aizpurúa
- Hospital Municipal, Rauch, Buenos Aires, Argentina
| | - C E L Sisnieguez
- 1] Clinica Medica, Hospital San Martín, La Plata, Buenos Aires, Argentina [2] Facultad de Ciencias Médicas, Universidad Nacional de La Plata, La Plata, Argentina
| | - B C L Sisnieguez
- 1] Clinica Medica, Hospital San Martín, La Plata, Buenos Aires, Argentina [2] Facultad de Ciencias Médicas, Universidad Nacional de La Plata, La Plata, Argentina
| | - C A Dulbecco
- 1] Clinica Medica, Hospital San Martín, La Plata, Buenos Aires, Argentina [2] Facultad de Ciencias Médicas, Universidad Nacional de La Plata, La Plata, Argentina
| | - C E March
- 1] Clinica Medica, Hospital San Martín, La Plata, Buenos Aires, Argentina [2] Facultad de Ciencias Médicas, Universidad Nacional de La Plata, La Plata, Argentina
| | - R N Stavile
- 1] Clinica Medica, Hospital San Martín, La Plata, Buenos Aires, Argentina [2] Facultad de Ciencias Médicas, Universidad Nacional de La Plata, La Plata, Argentina
| | - E H Ferrari
- 1] Clinica Medica, Hospital San Martín, La Plata, Buenos Aires, Argentina [2] Facultad de Ciencias Médicas, Universidad Nacional de La Plata, La Plata, Argentina
| | - M Correa
- 1] Clinica Medica, Hospital San Martín, La Plata, Buenos Aires, Argentina [2] Facultad de Ciencias Médicas, Universidad Nacional de La Plata, La Plata, Argentina
| | - P M Maciel
- Clinica Medica, Hospital San Martín, La Plata, Buenos Aires, Argentina
| | - E Balbín
- Clinica Medica, Hospital San Martín, La Plata, Buenos Aires, Argentina
| | - H A Carbajal
- Facultad de Ciencias Médicas, Universidad Nacional de La Plata, La Plata, Argentina
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21
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Use of the plasma triglyceride/high-density lipoprotein cholesterol ratio to identify cardiovascular disease in hypertensive subjects. ACTA ACUST UNITED AC 2014; 8:724-31. [DOI: 10.1016/j.jash.2014.08.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 08/04/2014] [Accepted: 08/07/2014] [Indexed: 01/13/2023]
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Li Y, Liu J, Wang W, Zhao D. The association between within-visit blood pressure variability and carotid artery atherosclerosis in general population. PLoS One 2014; 9:e97760. [PMID: 24835667 PMCID: PMC4024014 DOI: 10.1371/journal.pone.0097760] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 04/24/2014] [Indexed: 01/19/2023] Open
Abstract
Objectives To determine whether within-visit blood pressure (BP) variability based on three measurements over minutes is associated with increased carotid intima-media thickness (IMT) and plaque in a general population. Methods A cross-sectional survey was performed in 2007, and a total of 1222 Beijing community residents aged 50–79 years belonging to part of the Chinese Multi-Provincial Cohort Study (CMCS) were recruited in this study. BP was measured three times at 5-minute intervals during a single visit, and the maximum absolute difference (MAD) between any two readings of three measurements was used to indicate within-visit BP variability. Carotid IMT and plaque scanned by B-mode ultrasound were identified as the surrogate end points in the intermediate stage of atherosclerosis. Results After adjustment for established cardiovascular risk factors, the odds ratio (OR) (95% confidence interval (CI)) for increased carotid IMT and internal carotid plaque associated with the highest within-visit diastolic BP (DBP) variability (MAD > mean + standard deviation (SD)) compared with participants in the lowest within-visit DBP variability (MAD ≤ mean −SD) was 4.92 (1.48–16.42) and 6.07 (1.31–28.10), respectively, in the normotensives (P = 0.01; P = 0.02). The OR (95% CI) for internal carotid plaque associated with the highest within-visit systolic BP (SBP) variability (MAD >mean +SD) compared with participants in the lowest within-visit SBP variability (MAD ≤ mean −SD) was 3.54 (1.26–10.00) in the hypertensives on antihypertensive therapy (P = 0.02). Conclusions Within-visit DBP variability was associated with increased carotid IMT and internal carotid plaque in the normotensive population, and within-visit SBP variability was associated with internal carotid plaque in hypertensive patients undergoing antihypertensive therapy.
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Affiliation(s)
- Yan Li
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
- * E-mail:
| | - Jing Liu
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Wei Wang
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Dong Zhao
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
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Shafi T, Sozio SM, Bandeen-Roche KJ, Ephraim PL, Luly JR, St Peter WL, McDermott A, Scialla JJ, Crews DC, Tangri N, Miskulin DC, Michels WM, Jaar BG, Herzog CA, Zager PG, Meyer KB, Wu AW, Boulware LE. Predialysis systolic BP variability and outcomes in hemodialysis patients. J Am Soc Nephrol 2014; 25:799-809. [PMID: 24385593 DOI: 10.1681/asn.2013060667] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BP variability (BPV) is an important predictor of outcomes in the general population, but its association with clinical outcomes in hemodialysis patients is not clear. We identified 11,291 patients starting dialysis in 2003-2008 and followed them through December 31, 2008 (median=22 months). Predialysis systolic BPV was assessed over monthly intervals. Outcomes included factors associated with BPV, mortality (all-cause and cardiovascular), and first cardiovascular event (cardiovascular death or hospitalization). Patients' mean age was 62 years, 55% of patients were men, and 58% of patients were white. Modifiable factors associated with higher BPV included obesity, higher calcium-phosphate product levels, and lower hemoglobin concentration; factors associated with lower BPV included greater fluid removal, achievement of prescribed dry weight during dialysis, higher hemoglobin concentration, and antihypertensive regimens without β-blockers or renin-angiotensin system blocking agents. In total, 3200 deaths occurred, including 1592 cardiovascular deaths. After adjustment for demographics, comorbidities, and clinical factors, higher predialysis BPV was associated with increased risk of all-cause mortality (hazard ratio [HR], 1.18; 95% confidence interval [95% CI] per 1 SD increase in BPV, 1.13 to 1.22), cardiovascular mortality (HR, 1.18; 95% CI, 1.12 to 1.24), and first cardiovascular event (HR, 1.11; 95% CI, 1.07 to 1.15). Results were similar when BPV was categorized in tertiles and patients were stratified by baseline systolic BP. In summary, predialysis systolic BPV is an important, potentially modifiable risk factor for death and cardiovascular outcomes in incident hemodialysis patients. Studies of BP management in dialysis patients should focus on both absolute BP and BPV.
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Do level and variability of systolic blood pressure predict arterial properties or vice versa? J Hum Hypertens 2013; 28:316-22. [DOI: 10.1038/jhh.2013.106] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 09/09/2013] [Accepted: 09/18/2013] [Indexed: 12/19/2022]
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Visit-to-visit blood pressure variability and risk for progression of cardiovascular and renal diseases. Curr Opin Nephrol Hypertens 2013; 22:59-64. [PMID: 23165110 DOI: 10.1097/mnh.0b013e32835b489f] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW Recent data have highlighted the shortcomings of the usual blood pressure hypothesis in posthoc analyses of randomized controlled trials led in populations at high cardiovascular risk and have emphasized the importance of an increased visit-to-visit variability of blood pressure in predicting cardiovascular events. RECENT FINDINGS Over the last 2 years, the prognostic value of visit-to-visit blood pressure variability has been substantially confirmed in a wide spectrum of clinical populations, in studies investigating both cardiovascular outcomes and target organ damage. SUMMARY There is an obvious need to design studies to prospectively determine the causes of increased visit-to-visit blood pressure variability, its best estimate and whether or not treatments that reduce blood pressure variability (and to what extent/target) improve clinical outcome.
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Obara T, Kikuya M, Kobayashi Y, Ishikura K, Ikeda U, Ishikuro M, Metoki H, Mano N, Kuriyama S, Ohkubo T, Imai Y, the J-HOME-Morning Study Group. Associations Between Visit-to-visit Variability in Blood Pressure Measured in the Office and Antihypertensive Drugs: The J-HOME-Morning Study. Clin Exp Hypertens 2013; 35:285-90. [DOI: 10.3109/10641963.2013.780070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Blood pressure (BP) is characterized by marked short-term fluctuations occurring within a 24 h period (beat-to-beat, minute-to-minute, hour-to-hour, and day-to-night changes) and also by long-term fluctuations occurring over more-prolonged periods of time (days, weeks, months, seasons, and even years). Rather than representing 'background noise' or a randomly occurring phenomenon, these variations have been shown to be the result of complex interactions between extrinsic environmental and behavioural factors and intrinsic cardiovascular regulatory mechanisms. Although the adverse cardiovascular consequences of hypertension largely depend on absolute BP values, evidence from observational studies and post-hoc analyses of data from clinical trials have indicated that these outcomes might also depend on increased BP variability (BPV). Increased short-term and long-term BPV are associated with the development, progression, and severity of cardiac, vascular, and renal damage and with an increased risk of cardiovascular events and mortality. Of particular interest are the findings from post-hoc analyses of large intervention trials in hypertension, showing that within-patient visit-to-visit BPV is strongly prognostic for cardiovascular morbidity and mortality. This result has prompted discussion on whether antihypertensive treatment should be targeted not only towards reducing mean BP levels but also to stabilizing BPV with the aim of achieving consistent BP control over time, which might favour cardiovascular protection.
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Olmesartán con diuréticos o con antagonistas del calcio: ¿a qué perfil de paciente hipertenso? HIPERTENSION Y RIESGO VASCULAR 2013. [DOI: 10.1016/s1889-1837(13)70015-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Within-visit blood pressure variability: relevant factors in the general population. J Hum Hypertens 2012; 27:328-34. [PMID: 22971753 DOI: 10.1038/jhh.2012.39] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The objective of this study was to use a nationwide epidemiological survey to investigate the factors that affect within-visit blood pressure (BP) variability. We analyzed the Korean National Health and Nutrition Examination Survey (KNHNES) data for 2005 (n=5488). We examined three within-visit BP variability parameters that include the following: the alarm reaction (AR), defined as the first BP reading minus the third BP reading; the BP discrepancy, defined as the maximal BP reading minus the minimal BP reading (ΔBPmax); and the s.d. (BPSD). Age, fasting glucose, eGFR, total cholesterol, LDL cholesterol, and the metabolic syndrome (MetS) score were the relevant factors that affected the systolic AR, ΔSBPmax and SBPSD. Multiple linear regression models revealed that age (P<0.0001), the office systolic BP (SBP) level (P<0.0001), the MetS score (P<0.0001), the female gender (P=0.007) and the eGFR (P=0.049) were independently associated with the systolic AR, whereas age (P<0.0001), the office SBP level (P<0.0001), and the female gender (P=0.024 and 0.022) were independently associated with ΔSBPmax and SBPSD, respectively. Within-visit BP variability, especially the variability associated with the SBP, was significantly associated with increased age, female gender and cardiovascular risk factors, such as hypertension, low eGFR and adverse glucose and lipid profiles. In addition, increased age, female gender, the eGFR and the MetS score were independently relevant factors that affected the systolic AR. Systolic within-visit BP variability and systolic AR are associated with cardiovascular risk factors.
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