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Published on: December 15, 2023
Within-Visit Blood Pressure Variability and Cardiovascular Risk in ELSA-Brasil Study Participants
André Sant'Anna Zarife1,2, Helena Fraga-Maia3, José Geraldo Mill4
1Universidade Federal da Bahia - UFBA, Salvador , BA - Brasil.
Insights
Increased blood pressure variability (BPV) is linked to higher cardiovascular risk in both men and women. This risk is particularly pronounced in men, highlighting BPV as a key indicator for cardiovascular events.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Blood pressure variability (BPV) is a recognized prognostic indicator for cardiovascular outcomes.
- Understanding BPV's role in cardiovascular risk is crucial for preventative strategies.
Purpose of the Study:
- To investigate the association between within-visit blood pressure variability (BPV) and cardiovascular risk.
- To analyze this association in participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).
Main Methods:
- A cross-sectional study using baseline data from 14,357 ELSA-Brasil participants without prior cardiovascular disease.
- Within-visit BPV quantified by coefficient of variation of three standardized systolic blood pressure measurements.
- Cardiovascular risk assessed using the atherosclerotic cardiovascular disease (ASCVD) risk estimator and logistic regression.
Main Results:
- Higher cardiovascular risk was significantly associated with increased BPV in both sexes.
- Men exhibited a higher prevalence of high cardiovascular risk across all BPV quartiles compared to women.
- Significant associations between higher BPV quartiles and increased cardiovascular risk were observed in both men and women, with a stronger effect in men.
Conclusions:
- Within-visit blood pressure variability is associated with elevated cardiovascular risk.
- The association between BPV and cardiovascular risk is particularly significant in men.
Background:
Blood pressure variability (BPV) is of prognostic value for fatal and non-fatal cardiovascular outcomes.
Objective:
This study aimed to evaluate the association between within-visit BPV and cardiovascular risk among participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).
Methods:
The present cross-sectional study was carried out using baseline data (2008-2010) of 14,357 ELSA-Brasil participants with no prior history of cardiovascular disease. Within-visit BPV was quantified by the coefficient of variation of three standardized systolic blood pressure (SBP) measurements using an oscillometer. Anthropometric measurements and laboratory tests were also performed. Cardiovascular risk was assessed using the atherosclerotic cardiovascular disease risk estimator (ASCVD) and multivariate logistic regression analysis was employed with a significance level of 5%.
Results:
Significantly higher cardiovascular risk was determined by increased BPV for both sexes. A significantly higher prevalence of high risk was found in men than women across all quartiles, with the highest difference observed in the fourth quartile of variability (48.3% vs. 17.1%). Comparisons among quartiles in each sex revealed a significantly higher cardiovascular risk for men in the third (OR=1.20; 95%CI: 1.02 - 1.40) and fourth quartiles (OR=1.46; 95%CI: 1.25 -1.71), and for women in the fourth quartile (OR=1.27; 95%CI: 1.03 - 1.57).
Conclusion:
Analysis of baseline data of the ELSA-Brasil participants revealed that blood pressure variability was associated with increased cardiovascular risk, especially in men.
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Assessment of blood pressure in brachial artery(two-step method)
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Prepare for the Procedure:
Factors affecting Blood pressure
Physiological Factors:
Assessing Blood pressure in the Leg
Preparation:
Assessing Blood pressure using a doppler ultrasound
Pre-Procedural Guidelines for Doppler Ultrasound Blood Pressure Assessment:
Preparation of Equipment:
Special considerations while measuring blood pressure
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.

