Labile hypertension: a faulty concept? The Framingham study

Area of Science:

• Cardiology
• Epidemiology
• Preventive Medicine

Background:

• Labile blood pressure elevation is often considered less clinically significant than fixed hypertension.
• The predictive value of blood pressure variability for cardiovascular events requires further investigation.

Purpose of the Study:

• To examine the clinical significance of blood pressure lability compared to fixed hypertension.
• To determine if blood pressure variability adds predictive value for cardiovascular events beyond mean blood pressure.

Main Methods:

• Analysis of the Framingham cohort (5209 participants) over 20 years.
• Assessment of cardiovascular events in relation to routinely measured blood pressures across 10 biennial examinations.
• Evaluation of blood pressure variability using standard deviation and its correlation with cardiovascular disease risk.

Main Results:

• Blood pressure lability was not a consistent characteristic over time (r = 0.07).
• Higher blood pressures exhibited greater lability; "fixed hypertensives" had more labile pressures than "labile hypertensives."
• Blood pressure lability increased with age and did not improve cardiovascular disease prediction beyond mean blood pressure.

Conclusions:

• Average blood pressure is a sufficient predictor of cardiovascular disease risk.
• Blood pressure variability does not independently predict cardiovascular events.
• The average of serial blood pressure measurements, preferably over multiple examinations, should be used for risk assessment.