Systolic blood pressure visit-to-visit variability and outcomes in Asian patients with established or multiple risk factors for atherosclerotic cardiovascular disease: results from the CORE-Thailand

Abstract

Abstract Background It is well established that high blood pressure is associated with poor outcomes in many cardiovascular conditions. However, blood pressure (BP) is dynamic and may have variation during the follow-up. We aimed to assess the association between the systolic and diastolic blood pressure visit-to-visit variability (BP-VVV) and outcomes in Asian patients with established or multiple risk factors for atherosclerotic cardiovascular disease (ASCVD) in the Cohort Of patients with a high Risk of cardiovascular Events (CORE). Methods The CORE registry was a nationwide study enrolling patients with established atherosclerotic cardiovascular disease or those with multiple risk factors (at least three atherosclerotic risk factors) between April 2011 and March 2014 in 25 hospitals. Patients in the CORE registry with blood pressure measurements in at least three visits were included in the present study. BP-VVV was defined as the standard deviation (SD) of average blood pressure. Patients were grouped into quintiles of the SD of BP. The primary outcome was major adverse cardiac events (MACE), defined as all-cause mortality, all stroke, or myocardial infarction. The associations between BP-VVV (systolic and diastolic) and outcomes were assessed in the adjusted Cox regression model. The adjusted variables included age, sex, body weight, diabetes, chronic kidney disease, current smoking, established ASCVD, and treatment with ACEI or ARB. Restrict cubic spline was used to assess the association between SBP-VVV as a continuous variable and MACE in the adjusted Cox model. Results Of the 8,886 patients in the present study, 4041 patients (45.5%) were female, with a mean age of 65.6 years. The prevalence of hypertension was 95.9%. The mean SBP at baseline was 133 mmHg. The proportion of patients with established ASCVD was 51.1%. The mean follow-up time was 45.1 months. The Kaplan-Meier rate of MACE at five years was 15.8%. Spline analysis showed a J-curve association between SBP-VVV and MACE. The group with the highest SBP-VVV (the fifth quintile) had a significantly higher risk of MACE than the group with the lowest SBP-VVV (the first quintile) (adjusted hazard ratio 1.26, 95% CI 1.05-1.51). Compared with the group with the lowest SBP-VVV (the first quintile), the fifth quintile had a significantly higher risk of stroke, all MI, heart failure, and renal function deterioration. The risk of PAD and bleeding were similar among the quintiles. Conclusion SBP-VVV significantly impacted the long-term outcomes of Asian patients with established or multiple risk factors for ASCVD. Adequate SBP control and maintaining SBP stability over time may prevent adverse events in this population.SBP-VVV and MACE