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Blood pressure control measures and cardiovascular outcomes: a prospective hypertensive cohort
Konstantinos Sideris1, Ioannis Andrikou1, Costas Thomopoulos2
1First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece.
Insights
High blood pressure (BP) variability and poor time in therapeutic range (TTR) predict cardiovascular events in hypertensive patients. TTR is a stronger predictor than BP variability for future cardiovascular outcomes.
Area of Science:
- Cardiology
- Hypertension Management
- Clinical Research
Background:
- Hypertension is a major risk factor for cardiovascular disease.
- Effective blood pressure (BP) control is crucial for preventing cardiovascular events.
- Understanding the impact of BP variability and time in therapeutic range (TTR) on outcomes is important for optimizing treatment.
Purpose of the Study:
- To investigate the association between blood pressure (BP) control measures, visit-to-visit BP variability (BPV), and time in therapeutic range (TTR) with future cardiovascular outcomes in hypertensive patients.
- To compare the predictive power of BP-CV and TTR for cardiovascular events.
Main Methods:
- Prospective evaluation of 1,408 hypertensive patients without prior cardiovascular disease over 6 years.
- Estimation of visit-to-visit BPV using BP-CV (coefficient of variation of office systolic BP).
- Calculation of TTR as the percentage of office systolic BP measurements within the 120-140 mmHg range.
Main Results:
- Higher BP-CV (9.1±4.1%) and lower TTR (45±29%) were associated with increased cardiovascular events.
- Adjusted analysis showed BP-CV increased risk by 43% and TTR reduced risk by 33%.
- In a joint model, TTR demonstrated a greater impact on outcomes than BP-CV.
Conclusions:
- High visit-to-visit BP variability (BP-CV) and low time in therapeutic range (TTR) are linked to future cardiovascular events in treated hypertensive patients.
- TTR appears to be a more significant determinant of cardiovascular outcomes compared to BP-CV when evaluated together.
- These findings highlight the importance of both BP control metrics in managing hypertension and preventing cardiovascular complications.
Purpose:
We investigated whether blood pressure (BP) control measures, visit-to-visit BP variability, and time in therapeutic range (TTR) are associated with future cardiovascular outcomes in hypertensive patients.
Materials And Methods:
Among 1,408 hypertensive patients without cardiovascular disease, we prospectively evaluated the incident major cardiovascular events over 6 years. In newly diagnosed patients, antihypertensive drug treatment was initiated. We estimated two markers of on-treatment BP control, (1) visit-to-visit BPV as the coefficient of variation of office systolic BP (BP-CV), and (2) TTR calculated as the percentage of office systolic BP measurements within 120-140mmHg across visits.
Results:
The hypertensive cohort (672 males, mean age 60 years, 31% newly diagnosed) had a mean systolic/diastolic BP of 142/87 mmHg. The mean number of visits was 4.9 ± 2.6, while the mean attained systolic/diastolic BP during follow-up was 137/79 mmHg using 2.7 ± 1.1 antihypertensive drugs. The BP-CV and TTR were 9.1 ± 4.1% and 45 ± 29%, respectively, and the incidence of the composite outcome was 8.3% (n = 117). After adjustment for relevant confounders and standardization to z-scores, BP-CV and TTR were associated with a 43% (95% CI, 27-62%) increase and a 33% (95% CI, 15-47%) reduction in the outcome. However, the joint evaluation of TTR and BP-CV in a common multivariable model indicated that a standardized change of TTR was associated with the outcome to a greater extent than BP-CV (mean hazard ratios of 30% vs. 24%, respectively). When combined with the higher BP standardized-CV quartile, the lower TTR quartile predicted the outcome by 2.3 times (95% CI, 1.1-5.4) compared to the inverse TTR and BP-CV quartile pattern.
Conclusion:
High BP-CV or low TTR was associated with future cardiovascular events in a cohort of treated hypertensive patients. As a determinant, the extent of TTR value appears greater than BP-CV when these measures are considered in the same multivariable model.
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