Within-Subject Blood Pressure Level—Not Variability—Predicts Fatal and Nonfatal Outcomes in a General Population

• Published in: Hypertension (Dallas, Tex. 1979) Vol. 60; no. 5; pp. 1138 - 1147
• Main Authors: Schutte, Rudolph, Thijs, Lutgarde, Liu, Yan-Ping, Asayama, Kei, Jin, Yu, Odili, Augustine, Gu, Yu-Mei, Kuznetsova, Tatiana, Jacobs, Lotte, Staessen, Jan A
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD American Heart Association, Inc 01.11.2012; Lippincott Williams & Wilkins
• Subjects: Adrenergic beta-Antagonists - therapeutic use; Adult; Arterial hypertension. Arterial hypotension; Belgium - epidemiology; Biological and medical sciences; Blood and lymphatic vessels; Blood Pressure - physiology; Blood Pressure Determination - methods; Cardiology. Vascular system; Cardiovascular Diseases - diagnosis; Cardiovascular Diseases - mortality; Cardiovascular Diseases - physiopathology; Clinical manifestations. Epidemiology. Investigative techniques. Etiology; Female; Follow-Up Studies; Humans; Male; Medical sciences; Middle Aged; Multivariate Analysis; Outcome Assessment, Health Care; Prognosis; Risk Assessment; Risk Factors; Survival Rate; Young Adult; Belgium; Human; Hypertension; blood pressure variability; risk factors; Prognosis; Variability; Risk factor; Cardiovascular disease; Arterial pressure; Blood pressure; Epidemiology; population science
• ISSN: 0194-911X; 1524-4563
• DOI: 10.1161/HYPERTENSIONAHA.112.202143

To assess the prognostic significance of blood pressure (BP) variability, we followed health outcomes in a family-based random population sample representative of the general population (n=2944; mean age44.9 years; 50.7% women). At baseline, BP was measured 5 times consecutively at each of 2 home visits 2 to 4 weeks apart. We assessed within-subject overall (10 readings), within- and between-visit systolic BP variability from variability independent of the mean, the difference between maximum and minimum BP, and average real variability. Over a median follow-up of 12 years, 401 deaths occurred and 311 participants experienced a fatal or nonfatal cardiovascular event. Overall systolic BP variability averaged (SD) 5.45 (2.82) units, 15.87 (8.36) mmHg, and 4.08 (2.05) mmHg for variability independent of the mean, difference between maximum and minimum BP, and average real variability, respectively. Female sex, older age, higher-mean systolic BP, lower body mass index, a history of peripheral arterial disease, and use of β-blockers were the main correlates of systolic BP variability. In multivariable-adjusted analyses, overall and within- and between-visit BP variability did not predict total or cardiovascular mortality or the composite of any fatal plus nonfatal cardiovascular end point. For instance, the hazard ratios for all cardiovascular events combined in relation to overall variability independent of the mean, difference between maximum and minimum BP, and average real variability were 1.05 (0.96–1.15), 1.06 (0.96–1.16), and 1.08 (0.98–1.19), respectively. By contrast, mean systolic BP was a significant predictor of all end points under study, independent of BP variability. In conclusion, in an unbiased population sample, BP variability did not contribute to risk stratification over and beyond mean systolic BP.