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Published on: May 3, 2018
Visit-to-visit blood pressure variability and cardiovascular outcomes: a systematic review and dose-response
Mifetika Lukitasari1,2, Jitendra Jonnagaddala1,3, Siaw-Teng Liaw1,3
1School of Population Health, Level 5, Health Translation Hub, UNSW Kensington Campus, NSW 2052, Australia.
Insights
Visit-to-visit blood pressure variability (VVV BPV) reliably predicts cardiovascular disease (CVD) risk using electronic health records (EHR). Higher VVV BPV indicates increased CVD risk, supporting its clinical integration.
Area of Science:
- Cardiology and Cardiovascular Diseases
- Health Informatics and Electronic Health Records
- Biostatistics and Epidemiology
Background:
- Visit-to-visit blood pressure variability (VVV BPV) is an underutilized cardiovascular disease (CVD) risk factor.
- The reliability of electronic health record (EHR) data for estimating BPV and predicting CVD is uncertain.
- This study addresses the need to compare BPV estimation methods and their CVD prediction accuracy.
Purpose of the Study:
- To compare BPV estimation methodologies using EHR versus non-EHR data.
- To examine the dose-response associations between VVV BPV and CVD risk.
- To assess the clinical utility of EHR data for BPV assessment.
Main Methods:
- A systematic review and meta-analysis of studies published between January 2012 and August 2024.
- Inclusion of studies assessing VVV BPV in adults and its association with CVD outcomes.
- Dose-response meta-analysis (DRMA) to evaluate BPV thresholds (SD and CV) linked to CVD risk.
Main Results:
- 49 studies met inclusion criteria from 4,926 screened.
- VVV BPV was found to predict CVD outcomes, with comparable effect sizes between EHR (HR: 1.17) and non-EHR (HR: 1.14) data.
- A BPV threshold of SD ≥ 6.72 mmHg or CV ≥ 9.05% was associated with a 10% higher CVD risk.
Conclusions:
- EHR data reliably estimate VVV BPV, showing similar predictive power for CVD as non-EHR sources.
- A non-linear dose-response relationship exists, where higher VVV BPV significantly increases CVD risk.
- VVV BPV should be integrated into clinical practice, necessitating further research on implementation strategies.
Aims:
Visit-to-visit blood pressure variability (VVV BPV) is a recognized risk factor for cardiovascular disease (CVD) that is underutilized in clinical practice. The reliability of electronic health record (EHR) data in estimating BPV and predicting CVD remains uncertain. This study compared BPV estimation methodologies using EHR vs. non-EHR data and examined dose-response associations with CVD.
Methods And Results:
A systematic review and meta-analysis was conducted across five databases (MEDLINE, Scopus, EMBASE, CINAHL, and Web of Science) for studies published from January 2012 to August 2024. Studies assessing VVV BPV in adults and its association with CVD outcomes (e.g. myocardial infarction, stroke, heart failure, and cardiovascular mortality) were included. A dose-response meta-analysis (DRMA) evaluated BPV thresholds linked to increased CVD risk using standard deviation (SD) and coefficient of variation (CV). A total of 4926 studies were screened, 49 of which met the inclusion criteria. No consensus has emerged on BPV estimation methodologies, although non-EHR studies have followed stricter protocols. The meta-analysis showed that VVV BPV predicted any CVD outcome. Effect sizes were comparable between EHR [the hazard ratio (HR): 1.17, 95% confidence interval (CI): 1.09-1.24] and non-EHR (HR: 1.14, 95% CI: 1.10-1.17) studies (P-value = 0.468). A BPV threshold of SD 6.72 mmHg or CV 9.05% was linked to a 10% higher CVD risk.
Conclusion:
The EHR data reliably estimate BPV, yielding effect sizes similar to those of non-EHR sources. A non-linear dose-response relationship suggests that a higher BPV increases CVD risk. Visit-to-visit blood pressure variability needs to be incorporated into clinical practice, and further research is required to identify strategies to implement and scale up into routine workflow.
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