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Visit-to-visit blood pressure variability and cardiovascular death in the Systolic Hypertension in the Elderly
John B Kostis1, Jeanine E Sedjro, Javier Cabrera
1Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
Insights
Visit-to-visit blood pressure variability increases cardiovascular death risk. This association was stronger in patients receiving active treatment, suggesting medication adherence may play a role.
Area of Science:
- Cardiology
- Clinical Trials
- Public Health
Background:
- Previous studies on blood pressure variability and cardiovascular events are often short-term and lack placebo controls.
- Understanding long-term risks associated with blood pressure fluctuations is crucial for cardiovascular health.
Purpose of the Study:
- To investigate the association between visit-to-visit blood pressure variability and long-term cardiovascular mortality.
- To analyze this association within a placebo-controlled trial setting.
Main Methods:
- Utilized data from the Systolic Hypertension in the Elderly Program (SHEP), a double-blind, placebo-controlled trial.
- Examined cardiovascular cause mortality up to 17 years using the National Death Index.
- Adjusted for multiple demographic, clinical, and biochemical factors.
Main Results:
- Visit-to-visit blood pressure variability was significantly associated with cardiovascular death.
- The association was notably stronger in the active treatment group compared to the placebo group.
- Findings suggest potential roles for medication effects or inconsistent adherence.
Conclusions:
- Visit-to-visit blood pressure variability is a significant predictor of long-term cardiovascular mortality.
- The stronger association in the active treatment group warrants further investigation into medication adherence and its impact.
- These findings highlight the importance of stable blood pressure control in managing cardiovascular risk.
Abstract:
Most studies of an association of visit-to-visit variability of blood pressure with increased risk of future adverse cardiovascular events are of short duration and rarely include a placebo group. Using data from the double-blind, placebo-controlled Systolic Hypertension in the Elderly Program, the authors examined mortality from cardiovascular causes up to 17 years of follow-up using the National Death Index. Visit-to-visit blood pressure variability was associated with cardiovascular death after adjustment for sex, age, serum creatinine, diabetes, body mass index, smoking status, left ventricular failure, and high-density lipoprotein cholesterol. The relationship was significantly stronger in the active treatment group compared with the placebo group. Although this could be the result of an effect of the medications used unrelated to visit-to-visit variability, the data are compatible with the hypothesis that inconsistent adherence leading to missing active medication doses may be an additional explanation for the relationship of visit-to-visit variability with cardiovascular death.
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Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.