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Association of blood pressure variability with bone mineral density and incident hip fracture: the Cardiovascular
Alexander J Rodriguez1, Petra Buzkova2, Kenneth J Mukamal3
1Bone and Muscle Health Research Group, Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia; Division of Medicine, Monash Health, Clayton, Australia.
Insights
Blood pressure variability (BPV) showed no consistent link to hip fracture or bone mineral density (BMD) in this study. This suggests BPV may have limited clinical importance for bone health outcomes.
Area of Science:
- Gerontology
- Cardiovascular Health
- Orthopedics
Background:
- Blood pressure (BP), autonomic function, and atherosclerosis are linked to adverse bone outcomes.
- Blood pressure variability (BPV) may influence these bone-related outcomes.
- Previous studies on BPV and bone health were limited to Asian populations and few BPV measures.
Purpose of the Study:
- To investigate the association between BPV and hip fracture risk and bone mineral density (BMD).
- To examine BPV measures including SBP, DBP, and PP variability.
- To analyze these associations in a large, prospective, observational cohort.
Main Methods:
- Utilized data from the Cardiovascular Health Study (CHS) cohort.
- Estimated BPV using between-visit mean, slope, and standard deviation of residuals for SBP, DBP, and PP.
- Assessed incident hip fractures and total hip BMD in relation to BPV measures.
Main Results:
- No consistent association was found between BPV measures and hip fracture risk or BMD.
- A potential association between diastolic BP residual variability and hip fracture risk was observed in men only.
- No significant associations were identified in individuals using BP-lowering medications.
Conclusions:
- The study did not find a consistent association between BPV and BMD or hip fracture.
- Low BPV in this cohort might have limited the ability to detect associations.
- BPV may have limited clinical significance for adverse skeletal outcomes.
Background:
Blood pressure (BP), autonomic function and atherosclerosis are associated with adverse bone-related outcomes. These entities may affect blood pressure variability (BPV). The few studies that have directly investigated the association of BPV with hip fracture or bone mineral density (BMD) were limited to Asian populations and reported few BPV measures.
Methods:
Individuals with BP measurements at ≥4 of the 6 Cardiovascular Health Study (CHS), a large, prospective, observational cohort, visits between 1989 and 90 and 1994-95 and who attended the 1994-95 visit were included. Systolic (SBP), diastolic (DBP) and pulse pressure (PP) variability were estimated as: between-visit mean, between-visit slope (linear trajectory over time) and between-visit standard deviation (SD) of the observed residuals (departure from linear trajectory). Incident hip fractures between 1994 and 95 and 2015 were recorded. The association of BPV with hip fracture was estimated with Cox models (95% confidence intervals, CI). Primary analyses were conducted in individuals not using BP-lowering medications at baseline. Secondary analyses were conducted in those with stable use of BP-lowering medications during look back. Total hip BMD was measured at the 1994-95 study visit in a subset of individuals and analysed for cross-sectional associations with BPV.
Results:
Among 1820 individuals not using BP-lowering medications at baseline (60% women; age 76 ± 5 years), 292 incident hip fractures (222 women, 70 men) occurred. After multivariable adjustment, a one SD increase (3.12 mmHg) in DBP residual was associated with an 8.9% increased relative risk (95%CI, 0.4% to 18.2%) in men only. No other BPV measures were associated with hip fractures in men or women. No BPV measure was associated with BMD. Among 1958 individuals with stable BP medication use, 297 incident hip fractures (229 women, 68 men) occurred. In this group, no BPV measure was associated with incident hip fracture or BMD.
Conclusion:
We found no consistent association of BPV with BMD or hip fracture, which did not validate results from prior studies. Low BPV in this cohort may have limited our ability to identify associations with adverse skeletal outcomes but also may reflect limited clinical importance of BPV for bone.
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