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Association between within-visit blood pressure variability, stroke, coronary heart disease, and cardiovascular
Bhrugun Anisetti1, Hossam Youssef1, Ahamed M Elkhair1
1Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA.
Insights
Systolic blood pressure variability during a doctor's visit is linked to higher risks of stroke, coronary heart disease, and cardiovascular death. However, these associations are confounded by factors like age.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Long-term systolic blood pressure (SBP) variability is a known cardiovascular risk factor.
- Limited data exists on the association between within-visit SBP variability and adverse cardiovascular outcomes.
Purpose of the Study:
- To investigate the relationship between within-visit SBP variability and the risk of stroke, coronary heart disease (CHD), and cardiovascular (CV) death.
Main Methods:
- Analysis of 27,987 adults from the US National Health and Nutrition Examination Surveys (1999-2012).
- SBP was measured up to four times per visit; variability was the standard deviation of these measurements.
- Logistic and Cox regression models assessed associations with stroke, CHD, and CV mortality.
Main Results:
- Higher within-visit SBP variability was associated with increased prevalence of stroke.
- Increased SBP variability correlated with higher odds of stroke, CHD, and CV mortality.
- These associations were not significant after adjusting for covariates.
Conclusions:
- Within-visit SBP variability is linked to elevated risks of stroke, CHD, and CV mortality.
- The observed associations are confounded by age and other covariates.
Introduction:
Long-term variability in systolic blood pressure (SBP) is associated with a higher risk of cardiovascular events. Little is known about any association between within-visit SBP variability, stroke, coronary heart disease (CHD), and cardiovascular (CV) death.
Material And Methods:
Participants included adults ≥ 18 years who participated in the US National Health and Nutrition Examination Surveys from 1999 to 2012 linked to the national death index in 2012. Stroke was self-reported. SBP was obtained up to four times by a physician, using a manual sphygmomanometer according to standard procedures. Within-visit SBP variability was defined as the standard deviation of the BP measurements, stratified into quartiles. We evaluated the relationship between within-visit SBP variability and the odds of stroke or CHD using multivariable logistic regression, and with CV mortality, using multivariable Cox regression.
Results:
Of the 27,987 adults, 16.4% were aged ≥ 65 years, 51.3% were female, 71.2% were white, and 10.7% were black. Factors associated with higher mean SBP variability included older age, hypertension, chronic kidney disease, peripheral artery disease, and smoking (all p < 0.05). The prevalence of stroke significantly increased across SBP variability quartiles, from 2.1% for quartile 1 to 3.7% for quartile 4 (p < 0.001). High SBP variability was associated with higher odds of stroke [odds ratio (OR) 1.8, 95% confidence interval (CI) 1.4-2.2], coronary heart disease (OR 2.0, 95% CI 1.6-2.4), and increased risk of CV mortality [hazard ratio (HR) 2.7, 95% CI 2.3-3.1]. The relationships were not observed after adjusting for covariables.
Conclusions:
Within-visit variability in SBP is associated with increased risks of stroke, coronary heart disease, and cardiovascular mortality, but the relationship is confounded by age and covariates.
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