Abstract
Visit-to-visit variability (VVV) is a relatively new concept in the hypertensive arena. Data regarding VVV are lacking in our region, and factors associated with VVV are rarely examined in previous studies. This study was conducted among 406 patients attended to the cardiology outpatient department of Teaching Hospital, Jaffna, Sri Lanka, in 2018 to assess the long-term variability of blood pressure (BP) by reviewing last six consecutive BP readings from the records retrospectively. Data regarding sociodemographic variables and behavioural factors such as medication adherence, physical activity, smoking, alcohol consumption, and relevant comorbidities were taken through an interviewer-administered questionnaire. Data were analysed by using SPSS version 25 and VVV of systolic blood pressure (SBP) matrix expressed as mean of SD and association were examined with various factors and VVV of SBP. SBP showed high VVV among the participants as expressed by mean of SD which was 13.06 ± 5.64. When comparing mean SD among the categories of different variables, female sex (P=0.023) and comorbidities such as diabetes mellitus (DM) (P=0.013), chronic kidney disease (CKD) (P=0.007), and risk of developing obstructive sleep apnoea (OSA) (P=0.04) showed significant variation. Medication adherence to prescribed hypertensive medication was a major issue even though significant association was not found with high VVV (P=0.536). The SD of SBP was then classified into high and low VVV groups by means of a cutoff point at the 50th percentile. Bivariate analysis by using Chi-squared test revealed comorbidities such as DM, CKD, and physical activity (P=0.044) were significantly associated with high VVV. Further multivariate regression analysis revealed that comorbidities such as DM and CKD have 1.561 times and 5.999 times more risk to show high variability, respectively. In conclusion, we recommend simple practical measures to achieve sustainable BP control among hypertensive patients with DM and CKD to minimize the VVV and improve their cardiovascular outcome.
Highlights
Blood pressure fluctuation is a well-known phenomenon among patients with hypertension known as visit-to-visit variability (VVV)
Conclusion is study clearly demonstrates that VVV of blood pressure (BP) is high among our population and high VVV independently associated with comorbidities diabetes mellitus (DM) and chronic kidney disease (CKD)
The clinicians should not consider the adequacy of blood pressure control at a single visit as it is of marginal clinical importance
Summary
Blood pressure fluctuation is a well-known phenomenon among patients with hypertension known as visit-to-visit variability (VVV). VVV of blood pressure often dismissed as random fluctuation and is thought to be a limitation of measuring blood pressure at clinic settings [1]. Blood pressure variability could be classified into short-term, midterm, and long-term variability. Is study was performed among hypertensive patients (n 406) to assess the long-term variability by looking into their outpatient clinic records. Short-term variability in blood pressure is affected by behavioural, emotional, and postural influences on cardiovascular physiology and cardiac rhythm [6, 7]. Arterial stiffness contributes to both short-term and long-term variability of blood pressure [8, 9]
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