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Visit-to-visit SBP variability and cardiovascular disease in a multiethnic primary care setting: 10-year
Yook Chin Chia1, Siew Mooi Ching, Hooi Min Lim
1aDepartment of Primary Care Medicine, University of Malaya Primary Care Research Group (UMPCRG), Faculty of Medicine, University of Malaya, Kuala Lumpur bSunway Institute for Healthcare Development, Sunway University, Petaling Jaya cDepartment of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia dMalaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Malaysia.
Insights
High blood pressure variability (BPV) increases cardiovascular disease (CVD) risk, even with controlled systolic blood pressure (SBP). Managing both SBP and BPV is crucial for reducing CVD events in hypertensive patients.
Area of Science:
- Cardiology
- Hypertension Research
- Public Health
Background:
- Elevated systolic blood pressure (SBP) is a known risk factor for cardiovascular disease (CVD).
- Visit-to-visit variability in blood pressure (BPV) is increasingly recognized as a potential independent risk factor for adverse cardiovascular outcomes.
- Understanding the long-term impact of SBP variability in diverse primary care populations is essential for effective CVD prevention strategies.
Purpose of the Study:
- To investigate the association between long-term visit-to-visit variability of systolic blood pressure (SBP) and the incidence of cardiovascular disease (CVD).
- To determine if SBP variability is an independent predictor of CVD events in a multiethnic cohort of hypertensive patients.
- To compare the predictive value of SBP variability versus mean SBP levels for CVD events.
Main Methods:
- Retrospective cohort study of 807 hypertensive patients over 10 years.
- Blood pressure variability (BPV) derived from three-monthly clinic blood pressure readings.
- Cardiovascular events captured from patient records and analyzed using multivariate logistic regression.
Main Results:
- The study included 807 hypertensive patients (mean age 57.2 years, 63.3% women).
- Mean SBP was 142 mmHg, and mean BPV was 14.7 mmHg over 10 years; 13% experienced a cardiovascular event.
- BPV, not mean SBP, independently predicted CVD events. Lower BPV was associated with fewer events, irrespective of mean SBP levels.
Conclusions:
- Visit-to-visit blood pressure variability is a significant predictor of cardiovascular events, even when mean SBP is controlled.
- Reducing SBP variability, in addition to controlling SBP levels, is important for further reducing CVD risk.
- Factors such as male sex, diabetes, and ethnicity (Indian vs. Chinese) were also associated with increased CVD risk.
Objectives:
The current study aims to determine the relationship of long-term visit-to-visit variability of SBP to cardiovascular disease (CVD) in a multiethnic primary care setting.
Method:
This is a retrospective study of a cohort of 807 hypertensive patients over a period of 10 years. Three-monthly clinic blood pressure readings were used to derive blood pressure variability (BPV), and CVD events were captured from patient records.
Results:
Mean age at baseline was 57.2 ± 9.8 years with 63.3% being women. The BPV and mean SBP over 10 years were 14.7 ± 3.5 and 142 ± 8 mmHg, respectively. Prevalence of cardiovascular event was 13%. In multivariate logistic regression analysis, BPV was the predictor of CVD events, whereas the mean SBP was not independently associated with cardiovascular events in this population. Those with lower SBP and lower BPV had fewer cardiovascular events than those with the same low mean SBP but higher BPV (10.5 versus 12.8%). Similarly those with higher mean SBP but lower BPV also had fewer cardiovascular events than those with the same high mean and higher BPV (11.6 versus 16.7%). Other variables like being men, diabetes and Indian compared with Chinese are more likely to be associated with cardiovascular events.
Conclusion:
BPV is associated with an increase in CVD events even in those who have achieved lower mean SBP. Thus, we should prioritize not only control of SBP levels but also BPV to reduce CVD events further.
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