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Impact of Successive Office Blood Pressure Measurements During a Single Visit on Cardiovascular Risk Prediction:
Louis-Charles Desbiens1,2, Annie-Claire Nadeau-Fredette1,2, François Madore1,3
1Department of Medicine, Université de Montréal, Canada (L.-C.D., A.-C.N.-F., F.M., R.G.).
Insights
Using multiple office blood pressure readings, especially the third reading, improves cardiovascular risk prediction. Discarding the first reading enhances accuracy for long-term outcomes.
Area of Science:
- Cardiology
- Preventive Medicine
- Clinical Epidemiology
Background:
- Single office blood pressure (BP) readings have limited correlation with ambulatory BP.
- The long-term prognostic value of multiple office BP readings is not well-established.
- Improving cardiovascular risk prediction is crucial for patient outcomes.
Purpose of the Study:
- To assess the long-term impact of multiple office BP readings on cardiovascular outcomes.
- To determine if multiple BP readings improve cardiovascular risk prediction.
- To evaluate the association between successive BP readings and major adverse cardiovascular events (MACE).
Main Methods:
- Utilized data from the CARTaGENE population-based survey (n=17,966, aged 40-70).
- Obtained three sequential semiautomated BP readings (BP1, BP2, BP3) at 2-minute intervals.
- Assessed 10-year MACE incidence (cardiovascular death, stroke, myocardial infarction) using adjusted Cox models and C statistics for risk prediction.
Main Results:
- The third systolic BP (SBP3) reading showed the strongest association with MACE (HR 1.10 per SD), while SBP1 was weakest (HR 1.06).
- Models using SBP3 demonstrated superior cardiovascular risk prediction compared to SBP1 or averaged readings.
- Discarding the first SBP reading significantly improved risk prediction, with SBP3 offering the highest C statistic.
Conclusions:
- Successive office systolic BP readings, particularly the third, significantly enhance cardiovascular risk prediction.
- Discarding the initial BP reading and utilizing subsequent readings is recommended for improved prognostic accuracy.
- These findings underscore the clinical necessity of employing multiple office BP measurements.
Background:
Multiple office blood pressure (BP) readings correlate more closely with ambulatory BP than single readings. Whether they are associated with long-term outcomes and improve cardiovascular risk prediction is unknown. Our objective was to assess the long-term impact of multiple office BP readings.
Methods:
We used data from CARTaGENE, a population-based survey comprising individuals aged 40 to 70 years. Three BP readings (BP1, BP2, and BP3) at 2-minute intervals were obtained using a semiautomated device. They were averaged to generate BP1-2, BP2-3, and BP1-2-3 for systolic BP (SBP) and diastolic BP. Cardiovascular events (major adverse cardiovascular event [MACE]: cardiovascular death, stroke, and myocardial infarction) during a 10-year follow-up were recorded. Associations with MACE were obtained using adjusted Cox models. Predictive performance was assessed with 10-year atherosclerotic cardiovascular disease scores and their associated C statistics.
Results:
In the 17 966 eligible individuals, 2378 experienced a MACE during follow-up. Crude SBP values ranged from 122.5 to 126.5 mm Hg. SBP3 had the strongest association with MACE incidence (hazard ratio, 1.10 [1.05-1.15] per SD) and SBP1 the weakest (hazard ratio, 1.06 [1.01-1.10]). All models including SBP1 (SBP1, SBP1-2, and SBP1-2-3) were underperformed. At a given SBP value, the excess MACE risk conferred by SBP3 was 2× greater than SBP1. In atherosclerotic cardiovascular disease scores, SBP3 yielded the highest C statistic, significantly higher than most other SBP measures. In contrast to SBP, all diastolic BP readings yielded similar results.
Conclusions:
Cardiovascular risk prediction is improved by successive office SBP values, especially when the first reading is discarded. These findings reinforce the necessity of using multiple office BP readings.
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