FACTORS ASSOCIATED WITH AN INCREASED SYSTOLIC BLOOD PRESSURE VISIT- TO-VISIT VARIABILITY IN A TERTIARY HEALTH CARE CENTER

Abstract

Objective: Identify factors associated with an increased systolic blood pressure visit to visit variability in a “real-life” setting. Design and method: The study was observational, and retrospective. We included 2436 hypertensive outpatients, followed at our tertiary health care center, who had at least 8 visits with blood pressure readings. Epidemiological, clinical and therapeutic data were extracted and analyzed. Systolic blood pressure visit to visit variability was defined as the standard deviation around the mean systolic blood pressure of the 8 recordings. Results: The mean age of the population was 63.7 ± 10.9 years, and 55.7% of the patients were men. The proportions of diabetes, smoking, dyslipidemia and history of major cardiovascular events were 32.4%, 28.6%, 39.9% and 22.6% respectively. The mean blood pressure was 157.2 ± 11.7 / 90.8 ± 8.3 mmHg. The proportions of patients receiving one, two, three or more antihypertensive drugs at time of inclusion were 19.6%, 59.4% and 21% respectively. We found that age, systolic blood pressure, left ventricular hypertrophy, low eGFR, use of diuretics and use of beta-blockers were significantly associated with an increased systolic blood pressure variability. In a multiple regression analysis, the remaining independent factors were: age (p = 0.001), low eGFR (p = 0.003), use of diuretics (p = 0.0001) and treatment with beta-blockers (p = 0.0001). Conclusions: Among factors affecting blood pressure visit to visit variability in our hypertension unit, the most deleterious are related to the type of drug prescribed, suggesting that limiting the use of these medications, at least in the first step, could result in a risk reduction of cardiovascular events linked to blood pressure visit to visit variability.