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Association of Variability and Hypertensive Loads in 24-h Blood Pressure With Mortality and Cardiovascular Risk
Jesus D Melgarejo1,2,3,4, Dhrumil Patil5, Luis J Mena6
1Institute of Neuroscience, Neuro and Behavioral Health INtegrated Service Unit, School of Medicine, University of Texas Rio Grande Valley, Harlingen, Texas, USA.
American Journal of Hypertension
|January 31, 2024
Summary
High 24-hour blood pressure variability, measured by average real variability (ARV), independently predicts mortality and cardiovascular risk. Hypertensive loads also increase risk, but ARV is the key independent predictor.
Area of Science:
- Cardiology
- Hypertension Research
- Clinical Epidemiology
Background:
- Elevated 24-hour blood pressure (BP) variability is a known cardiovascular risk factor.
- The independent contributions of inherent BP variability versus hypertensive loads to long-term outcomes require further elucidation.
Purpose of the Study:
- To determine if 24-hour BP variability, specifically average real variability (ARV), and 24-hour systolic BP load are associated with mortality and major adverse cardiovascular endpoints (MACE).
- To assess whether these associations persist independently of the overall BP level.
Main Methods:
- 1,050 participants from the Maracaibo Aging Study underwent 24-hour ambulatory BP monitoring.
- Average real variability (ARV) quantified inherent BP variability, while 24-hour systolic BP load represented the proportion of readings above hypertensive thresholds.
- Cox proportional models were used to analyze the association between BP variability metrics, BP load, and outcomes over a median follow-up of 8.3 years.
Main Results:
- Higher 24-hour systolic ARV was significantly associated with increased hazard ratios for both mortality and MACE.
- Increased 24-hour systolic BP load also correlated with higher risks of mortality and MACE.
- After adjusting for mean BP levels, only ARV remained a significant independent predictor of mortality and MACE.
Conclusions:
- Both high average real variability (ARV) and hypertensive loads in 24-hour systolic blood pressure are linked to increased mortality and cardiovascular risk.
- Average real variability (ARV) emerges as an independent predictor of these adverse outcomes, even after accounting for the average blood pressure level.
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