Abstract
Background: Systolic or diastolic blood pressure (BP) variability is associated with an increased risk of cardiovascular events. We assessed whether BP variability measured by mean arterial pressure (MAP) was associated with increased risk of heart failure (HF) and death in individuals with or without hypertension.Methods: We evaluated 9,305 Atherosclerosis Risk in Communities (ARIC) study participants with or without hypertension and calculated BP variability based on MAP values from visit 1 to 4 [expressed as standard deviation (SD), average real variability (ARV), coefficient of variation (CV), and variability independent of the mean (VIM)]. Multivariate-adjusted Cox regression model and restricted cubic spline curve were used to evaluate the associations of MAP variability with all-cause mortality and HF.Results: During a median follow-up of 16.8 years, 1,511 had an HF event and 2,903 died. Individuals in the highest quartile of VIM were both associated with a 21% higher risk of all-cause mortality [hazard ratio (HR), 1.21; 95% CI, 1.09–1.35] and HF (HR, 1.21; 95% CI, 1.04–1.39) compared with the lowest quartile of VIM. Cubic spline curves reveal that the risk of deaths and HF increased with MAP variability when it reached a higher level. Results were similar in individuals with normotension (all-cause mortality: HR, 1.30; 95% CI, 1.09–1.55; HF, HR, 1.49; 95% CI, 1.12–1.98).Conclusions: In individuals with or without hypertension, greater visit-to-visit MAP variability was associated with a higher risk of all-cause mortality and HF, indicating that the BP variability assessed by MAP might be a potential risk factor for HF and death.
Highlights
The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) [1] and 2018 European Society of Cardiology (ESC)/European Society of Hypertension (ESH) [2] blood pressure (BP) guideline recommends using a single measurement or the average of BP levels assessed over time to screen for and manage high BP in adults, while occasional BP increase or reduction has not been taken seriously by clinicians
In the multivariable-adjusted model, the highest quartile of variability independent of the mean (VIM) was both associated with a 21% higher risk of all-cause mortality (HR, 1.21; 95% CI, 1.09–1.35) and heart failure (HF) (HR, 1.21; 95% CI, 1.04– 1.39) compared with the lowest quartile of VIM (Q1) (Table 2)
No significant differences in the risk of incident death and HF were found in moderate quartile of VIM (Q2) and in high quartile of VIM (Q3) (Table 2)
Summary
The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) [1] and 2018 European Society of Cardiology (ESC)/European Society of Hypertension (ESH) [2] blood pressure (BP) guideline recommends using a single measurement or the average of BP levels assessed over time to screen for and manage high BP in adults, while occasional BP increase or reduction has not been taken seriously by clinicians. Fluctuation of BP is physiological [3], a growing number of clinical and observational studies have demonstrated that elevated BP variability contributes to the risk of cardiovascular disease (CVD) and death, independently of mean BP [4,5,6,7,8,9,10,11,12]. Few studies to date have evaluated the potential impact of long-term mean arterial pressure (MAP) variability on CVD and death. We assessed whether BP variability measured by mean arterial pressure (MAP) was associated with increased risk of heart failure (HF) and death in individuals with or without hypertension
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