Visit-to-visit blood pressure variability in patients after acute coronary syndrome

Abstract

Objective. The aim of the study was to assess the possible association of visit-to-visit blood pressure (BP) variability and the risk of adverse outcomes in hypertensive (HTN) patients after acute coronary syndrome.Design and methods. We analyzed data of 1,456 patients (mean age 65,6 ± 12,2 years, 875 (60,1 %) men) discharged from the hospital after acute coronary syndrome and followed up for 1 year in 4 vascular centers in Moscow, Astrakhan, Kazan and Krasnodar in 2014–2017. BP, heart rate, and adverse events were recorded on the day of discharge and on days 25, 90, 180 and 360 after discharge. The visit-to-visit BP variability was assessed by the VIM coefficient (variation independent of mean).Results. The systolic BP variability was 7,81 ± 0,226 mm Hg, diastolic BP variability was 9,89 ± 0,577 mm Hg during follow-up. In total, 110 deaths from any cause, 63 coronary deaths, 130 repeated non-fatal coronary events, 33 ischemic strokes were recorded. A decrease in BP variability was associated with the dihydropyridine calcium antagonists (10,21 ± 6,45 and 7,99 ± 4,70 mm Hg, p = 0,024) and thiazide diuretics (10,34 ± 6,59 and 7,63 ± 9,63 mm Hg, p = 0,049). Multivariate analysis showed that high long-term variability of BP is a more significant factor associated with the overall mortality rate than the initial severity of HTN and even the fact of achieving target BP. The risk of ischemic stroke in patients with HTN was associated with factors such as atrial fibrillation, heart failure, a history of stroke, and high visit-to-visit BP variability.Conclusions. Visit-to-visit BP variability is an important characteristic of BP control and is associated with the risk of death from any causes and stroke in patients with coronary heart disease.