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Individual 6-year systolic blood pressure change and impact on cardiovascular mortality in a French general
Insights
Visit-to-visit blood pressure (BP) change predicts mortality in hypertensive patients but not in normotensive individuals. This study highlights BP variability as a key factor for cardiovascular outcomes in those with high blood pressure.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Visit-to-visit blood pressure (BP) variability's impact is debated, particularly in untreated hypertensive and normotensive individuals.
- Previous research has not definitively established the association between systolic BP changes over time and mortality in diverse primary care populations.
Purpose of the Study:
- To investigate the relationship between 6-year systolic blood pressure (SBP) change and all-cause and cardiovascular disease (CVD) mortality.
- To determine if BP variability is an independent predictor of mortality in untreated hypertensive and normotensive subjects within a primary care setting.
Main Methods:
- A cohort study involving 40,926 normotensive and 14,283 untreated hypertensive individuals with two BP measurements (V1 and V2) over a 5.8-year interval.
- Mortality data (all-cause and CVD) were collected over a 6.1-year follow-up period.
- Multivariate Cox models were used to analyze the association between SBP change (assessed by tertiles) and mortality, adjusting for baseline and follow-up BP parameters.
Main Results:
- Increased SBP change was significantly associated with higher all-cause and CVD mortality in the overall population and specifically in hypertensive individuals, even after adjusting for baseline BP.
- For hypertensive individuals, SBP change showed a hazard ratio (HR) of 1.31 for all-cause mortality and 2.51 for CVD mortality.
- No significant association between SBP change and mortality was observed in individuals who were normotensive at the initial visit.
Conclusions:
- Long-term, visit-to-visit systolic blood pressure change is an independent predictor of all-cause mortality in hypertensive individuals within a primary care population.
- BP variability does not appear to be a significant predictor of mortality in individuals with normal blood pressure.
- These findings underscore the importance of monitoring BP variability in hypertensive patients for risk stratification and improved clinical outcomes.
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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