Long-term Blood Pressure Variability Research Articles

The utility of long-term blood pressure variability for cardiovascular risk prediction in primary care.

Blood pressure (BP) is a long-established risk factor for cardiovascular disease (CVD). SBP is used in all widely used cardiovascular risk scores for clinical decision-making. Recently, within-person BP variability has been shown to be a major predictor of CVD. We investigated whether cardiovascular risk scores could be improved by incorporating BP variability with standard risk factors. We used cohort data on patients aged 40-74 on 1 January 2005, from English general practices contributing to the Clinical Practice Research Datalink, a research database derived from electronic health records. Data were linked to hospital episodes and mortality data. SBP variability independent of the mean was calculated across up to six clinic visits. We divided data geographically into derivation and validation data sets. In the derivation data set, we developed a reference model, incorporating risk factors used in previous scores and an index model, incorporating the same factors and BP variability. We calculated model validation statistics in the validation data set including calibration ratio and c-statistic. In the derivation data set, BP variability was associated with CVD, independently of other risk factors (P = 0.005). However, in the validation data set, both models had similar c-statistic (0.7415 and 0.7419, respectively), R (31.8 and 32.0, respectively) and calibration ratio (0.938 and 0.940, respectively). The association of BP variability with CVD is statistically significant in a large data set but does not substantially improve the performance of a cardiovascular risk score.

The Association between Long- and Intra-Dialytic Blood Pressure Variability with All-Cause Mortality in Hemodialysis Patients

Background: Blood pressure variability (BPV) is a potential prognostic predictor for all-cause mortality. Objectives: We conducted a retrospective cohort study to compare the prognostic value of long-term BPV with intra-dialytic BPV in hemodialysis (HD) patients. Materials and Methods: We included 611 HD patients and collected their baseline blood pressure (BP) measurements for 1 year and monitored them for 40 months. Long-term BPV was assessed by pre-dialysis BP SD and pre-dialysis absolute BP residual metric. Intra-dialytic BPV was assessed by intra-dialytic BP average real variability and intra-dialytic absolute BP residual. Results: Long-term systolic BPV showed a weak correlation with mean BP, but a stronger correlation with intra-dialytic BPV. High long-term systolic blood pressure (SBP) SD and long-term SBP residual metrics were associated with high all-cause mortality (p = 0.0084 and 0.0056, respectively), while no such association was found for intra-dialytic BPV or diastolic BPV. According to receiver operating characteristic curve with mortality as dependent variable, long-term SBP residual metric showed the strongest prognostic ability (area under curve [AUC] 0.679, p = 0.0006), which was even stronger in patients with BP ≥140/90 mm Hg (AUC 0.713, p = 0.0004). After completely adjusting for confounders, long-term SBP residual metric remained significantly associated with all-cause mortality (hazard ratio 1.628 per quartile; 95% CI 1.086–2.441). Conclusions: Our results suggest long-term SBP residual metric to be a better predictor of all-cause mortality in HD patients, which could be used as an additional target for BP management.

Abstract TMP87: Beat-to-beat Blood Pressure Accurately Predicts Subsequent Arm Cuff Blood Pressure Variability in Acute Ischemic Stroke Patients

Introduction: Higher blood pressure variability (BPV) is associated with worse outcome after stroke. Accurate quantification of BPV requires frequent measurements, which is not practical with arm cuff sphygmomanometry. Hypothesis: 15 minutes of beat-to-beat BPV (bBPV) will accurately predict arm cuff BPV (aBPV) for acute ischemic stroke patients' entire hospitalization. Methods: To measure aBPV, we used all arm cuff blood pressures during hospitalization. We measured bBPV with a finger photo-plethysmographer (Figure 1) for 15 minutes. We report Pearson’s correlation coefficient for 5 different statistical estimations of variability. Results: We enrolled 30 patients with acute ischemic stroke. Mean age was 60.9 years, NIHSS was 5.4, and 19/30 were male. The mean days from stroke onset to bBPV measurement was 2, and the mean length of hospitalization was 5 days. The mean number of arm cuff and beat-to-beat blood pressure measurements was 62 and 1,830. Correlation between aBPV and bBPV was moderate to excellent (Table 1 and Figure 2). Conclusion: This pilot study demonstrates the feasibility of predicting long-term BPV with 15 minutes of finger photo-plethysmography. As opposed to deriving BPV from arm cuff measurements, which takes days, our approach allows early and rapid identification of patients who will subsequently have high BPV and may benefit from therapeutic intervention.

Long-term blood pressure variability and development of chronic kidney disease in type 2 diabetes.

Long-term visit-to-visit SBP variability (VVV) has been shown to predict cerebro-cardiovascular events and end-stage renal disease in chronic kidney disease (CKD) patients. Whether SBP VVV is also a predictor of CKD development in diabetes is currently uncertain. We assessed the role of SBP VVV on the development of CKD in patients with type 2 diabetes (T2D) and hypertension in real life. Clinical records from 30 851 patients with T2D and hypertension, with normal estimated glomerular filtration rate (eGFR) and regular visits during a 4-year follow-up were analyzed. SBP variability was measured by three metrics: coefficient of variation; SD of the mean SBP and average absolute difference of successive values in each individual. CKD was defined as eGFR less than 60 and/or a reduction in eGFR at least 30% from baseline. Over the 4-year follow-up, 9.7% developed eGFR less than 60 and 4.5% an eGFR reduction at least 30% from baseline. Several clinical characteristics (older age, male sex, SBP, DBP, albuminuria, glycated hemoglobin, insulin treatment) were related to intraindividual SBP variability. Patients with VVV in the upper quintile showed an increased risk of developing both components of CKD [adjusted odds ratio (OR) 1.21, P < 0.001 and 1.32, P < 0.001, respectively]. The multivariable adjusted ORs of SBP coefficient of variation quintiles 2-5 for the incidence of CKD were incrementally higher (OR 1.04, P = 0.601, OR 1.05, P = 0.520, OR 1.21, P < 0.017 and OR 1.42, P < 0.001 as compared with the first quintile). Increased long-term BP variability predicts CKD in patients with T2D and hypertension.

Different Types of Blood Pressure Variability in Hypertensive Patients with Chronic Lower Airway Diseases

In hypertensive patients, blood pressure variability (BPV) and comorbidity are associated with prognosis. However, there have been no complex prospective studies of BPV in patients with hypertension and chronic lower airway diseases (CLAD). Aim. To investigate specific features of different BPV types and their prognostic value in hypertensive patients with and without CLAD in a prospective study. Material and methods. This prospective cohort study included hypertensive patients, approximately half of whom had asthma or chronic obstructive pulmonary disease (COPD). Clinic blood pressure (BP) measurements, ambulatory and home BP monitoring (ABPM, HBPM), spirometry, clinical blood analysis and blood chemistry, and a standard questionnaire and physical examination were performed at baseline and 12 months later. Clinical BP measurements and HBPM were also repeated 6 months after the baseline visit. At 12 months from the last study visit, we collected the information about cardiovascular complications and deaths. Statistical methods included ANOVA and survival analysis. The BPV indices were calculated as SD for different time periods, ARV (average real variability), and VIM (variation independent of mean). The inter-group comparisons were adjusted for age and sex. The assessment of intra-visit and long-term BPV was based on clinical BP measurement. The assessment of 24-hour BPV and mid-term BPV was based on ABPM and HBPM, respectively. Results. The BPV levels, assessed by ABPM and HBPM, were higher in patients with CLAD. There were no long-term BPV differences between two groups, in according to clinical BP data. Higher levels of daytime BPV were associated with orthostatic systolic BP, baseline forced expiratory volume in 1 second (FEV1), and glomerular filtration rate (GFR). An increase in nighttime BPV was associated with COPD, serum creatinine, FEV1 after β2-agonist inhalation, and GFR. In the CLAD group, the cumulative survival was lower, while the total risk was higher. The following endpoint predictors were identified: supraventricular arrhythmias, SD of nighttime diastolic BP, blood leukocyte count and nocturnal BP fall (Wald Chi-Square 14.780- 4.257; p&lt;0.0001-0.026). Conclusion. The main BPV indices are higher in patients with asthma and COPD, in comparison with CLAD-free hypertensive patients. ABPM is the most reliable method of BPV assessment in hypertensive patients with CLAD, according to our data. The increase in BPV is associated with irreversible airway obstruction and renal function. Adverse outcomes were associated with both nighttime BPV and nocturnal BP fall, as well as with rhythm disorders and leukocyte count as a marker of systemic inflammation. BPV in patients with CLAD warrants further investigation.

Long-term Systolic Blood Pressure Variability Promotes a Decline in the Renal Function in Middle-aged and Older Males

Long-term Systolic Blood Pressure Variability Promotes a Decline in the Renal Function in Middle-aged and Older Males

Advantages of control over the course of hypertension disease with the fixed combination of amlodipine and perindoprilе arginin

Background. To improve the prognosis and quality of life of patients with essential hypertension, it is necessary to search for combinations of antihypertensive drugs that can affect all parameters of blood pressure (BP) and restrict remodeling of target organs. Aim. To study the effect of free and fixed combination of angiotensin converting enzyme inhibitor (perindopril arginine) and dihydropyridine calcium antagonist (amlodipine) on BP parameters, target organs damage criteria and quality of life of hypertensive patients. Materials and methods. The study included 92 patients suffering from arterial hypertension (AH) II and III stages. The 1st group included patients who received within 12 months treatment in a free combination of an angiotensin converting enzyme inhibitor (perindopril arginine) and amlodipine, in the 2nd group - in a fixed combination. The changes in BP indices were compared, including BP variability, criteria for target organs remodeling and quality of life assessed using the SF-36 questionnaire. Results. The results of office and 24-hour BP monitoring at the study stages demonstrated better control of all BP indices in patients of the 2nd group, reduction of short-, medium- and long-term BP variability. Against the background of treatment with a fixed combination of amlodipine and perindopril arginine, there were significantly more significant changes in 3 parameters of target organs remodeling: glomerular filtration rate, microalbuminuria, ankle-brachial index, and restoration of diastolic function of the left ventricle. At the same time, different positive dynamics of the quality of life indicators of patients of both study groups were noted. Conclusion. Fixed combined full-dose antihypertensive therapy with amlodipine and perindopril arginine allows achieving BP targets (including BP variability) in the majority of patients with AH II and III stages with high and very high risk of cardiovascular complications. High adherence to therapy allowed not only to maintain all parameters of blood pressure at the target level within a year, but also significantly improve the parameters of target organs remodeling and the quality of life of patients

Impact of body mass index on long-term blood pressure variability: a cross-sectional study in a cohort of Chinese adults

BackgroundObesity and overweight are related to changes in blood pressure, but existing research has mainly focused on the impact of body mass index (BMI) on short-term blood pressure variability (BPV). The study aimed to examine the impact of BMI on long-term BPV.MethodsParticipants in the Kailuan study who attended all five annual physical examinations in 2006, 2008, 2010, 2012, and 2014 were selected as observation subjects. In total, 32,482 cases were included in the statistical analysis. According to the definition of obesity in China, BMI was divided into four groups: underweight (BMI < 18.5 kg/m2), normal weight (18.5 ≤ BMI < 24.0 kg/m2), overweight (24.0 ≤ BMI < 28.0 kg/m2), and obese (BMI ≥ 28.0 kg/m2). We used average real variability to evaluate long-term systolic BPV. The average real variability of systolic blood pressure (ARVSBP) was calculated as (|sbp2 − sbp1| + |sbp3 − sbp2 | + |sbp4 − sbp3| + |sbp5 − sbp4|)/4. Differences in ARVSBP by BMI group were analyzed using analysis of variance. Stepwise multivariate linear regression and multiple logistic regression analyses were used to assess the impact of BMI on ARVSBP.ResultsParticipants’ average age was 46.6 ± 11.3 years, 24,502 were men, and 7980 were women. As BMI increases, the mean value of ARVSBP gradually increases. After adjusting for other confounding factors, stepwise multivariate linear regression analysis showed that ARVSBP increased by 0.077 for every one-unit increase in BMI. Multiple logistic regression analysis indicated that being obese or overweight, compared with being normal-weight, were risk factors for an increase in ARVSBP. The corresponding odds ratios of being obese or overweight were 1.23 (1.15–1.37) and 1.10 (1.04–1.15), respectively.ConclusionsThere was a positive correlation between BMI and ARVSBP, with ARVSBP increasing with a rise in BMI. BMI is a risk factor for an increase in ARVSBP.Trial registrationRegistration No.: CHiCTR-TNC1100 1489; Registration Date: June 01, 2006.

A2493 The optimal blood pressure parameters for prediction of target organ damages in hypertensive patients

Objectives: To explore the relationship of different blood pressure (BP) parameters with target organ damages (TODs) and to determine the optimal BP parameters with a high accuracy of prediction. Methods: We assessed the left ventricular mass index (LVMI) and carotid intima-media thickness (CIMT) using ultrasonography and microalbuminuria (MAU) as measures of TODs in 266 hypertensive patients without previous treatments. BP were collected using the office BP, home BP and 24 h ambulatory BP, and the BPV was evaluated using coefficient of variation (CV). Results: In the univariable and multivariable linear regression analysis, ambulatory SBP and mean home SBP were always significantly correlated with LVMI, CIMT and MAU (all P < 0.05); However, there was no independent association with all three TOD indices in terms of DBP, mean office SBP and maximum SBP, and long-term BP variability (BPV) parameters (all P > 0.05); Short-term SBPV and pulse pressure (PP) were not always correlated with all three TODs indices. Multivariate logistic regression analysis showed that 24 h SBP, day-time SBP, night-time SBP and mean home SBP were still the top four BP parameters independently and significantly associated with left ventricle hypertrophy (LVH), carotid atherosclerosis (CAS) and albuminuria (all P < 0.05). Receiver operating characteristic (ROC) curves showed that ambulatory SBP and mean home SBP had a high predictive value for TODs. Conclusion: Ambulatory SBP and mean home SBP may be the most important and optimal BP parameters for accurate prediction of TODs. In clinical applications, they can be used as the preliminary screening indicators for predicting TODs in hypertensive patients.

Blood Pressure Coefficient of Variation and Its Association With Cardiac Surgical Outcomes.

Multiple studies completed in the ambulatory nonsurgical setting show a significant association between short- and long-term blood pressure variability and poor outcomes. However, perioperative blood pressure variability outcomes have not been well studied, especially in the cardiac surgical setting. In this study, we sought to assess whether systolic and mean arterial blood pressure variability were associated with 30-day mortality and in-hospital renal failure in patients undergoing cardiac surgery requiring cardiopulmonary bypass. Furthermore, blood pressure variability has not been evaluated specifically during each phase of surgery, namely in the pre-, intra- and postbypass phases; thus, we aimed also to assess whether outcomes were associated with phase-specific systolic and mean arterial blood pressure variability. All patients undergoing cardiac surgery from January 2008 to June 2014 were enrolled in this retrospective, single-center study. Demographic, intraoperative, and postoperative outcome data were obtained from the institution's Society of Thoracic Surgery database and Anesthesia Information Management System. Systolic and mean arterial blood pressure variability were assessed using the coefficient of variation (CV). The primary outcomes were 30-day mortality and in-hospital renal failure in relation to the entire duration of a case, while the secondary outcomes assessed phase-specific surgical periods. In an effort to control the family-wise error rate, P values <.0125 were considered significant for the primary outcomes. Of the 3687 patients analyzed, 2.7% of patients died within 30 days of surgery and 2.8% experienced in-hospital renal failure. After adjusting for significant covariates, we found a statistically significant association between increasing CV for systolic blood pressure (CVSBP) and 30-day mortality and in-hospital renal failure. For every 0.10 increase in CVSBP, there was a 150% increase in the odds of death (odds ratio, 2.50; 95% confidence interval, 1.60-3.92; P < .0001) and there was a 104% increase in odds of experiencing renal failure (odds ratio, 2.04; 95% confidence interval, 1.33-3.14; P = .001). The association with mortality was driven primarily by the prebypass period, because the association between CVSBP and mortality during the prebypass phase was significant (P = .01), and not during the postbypass phase (P = .08). There was no significant association between CV for mean arterial blood pressure and either death or renal failure during any period of surgery, including the bypass phase. Increasing systolic blood pressure variability was associated with 30-day mortality and development of renal failure, with surgery phase-specific relationships observed. Further research is required to determine how to prospectively detect blood pressure variability and elucidate opportunities for intervention.

A7619 Association between long-term blood pressure variability and brachial-ankle pulse wave velocity progression in prehypertension patients over a 5 years follow-up

Objectives: Studies suggested that higher systolic blood pressure (SBP) variability reduces bio-availability of nitric oxide and increases vascular smooth muscle cell proliferation. These vascular wall changes could stiffen the arterial wall. We investigated the association between long-term SBP variability and 5-year change in brachial-ankle pulse wave velocity among 204 prehypertension individuals. Methods: We enrolled 204 individuals with prehypertension at baseline and three follow-up visits in the study (mean age 67.5 ± 12.6 years, 45% males). At baseline physical examination, BP, laboratory data and ba-PWV were assessed. A ba-PWV follow-up examination was performed with a median time amounting to 5.25 ± 0.53 years. Within-individual standard deviation (SD), variability independent of the mean (VIM), and coefficient of variation (CV) of SBP across 3 visits were used to capture long-term SBP variability. Results: In a multivariate linear regression model, individuals in the 5th quintile as compared to those in the 1st quintile of SD, VIM, and CV of SBP had a 17.5% (95% CI: 15.8%, 19.3%), 15.8% (95% CI: 14.7%, 18.9%), and 16.9% (95% CI: 16.8%, 18.1%) higher progression in ba-PWV, respectively, after 5 years of follow-up. Conclusion: Linear trends in the progression of ba-PWV were observed across the quintiles of SBP variability indices. This finding suggest that higher long-term SBP variability may be a risk factor for arterial stiffness progression independent of mean BP in prehypertension subjects.

A17293 Relationship between amount of salt intake and long-term blood pressure variability

Objectives: Existing data indicate that blood pressure (BP) variability is a strong predictor of cardiovascular events in patients with arterial hypertension (AH). In spite of known influence of salt intake amount on BP level, relationship between amount of salt intake and BP variability (BPV) still needs investigation. Methods: 50 men with AH (mean age 55.94 ± 9.8 years) underwent to three different 10 day salt intake diets: regular (9–12 g/day), low (2.5–4 g/day) and high (>20 g/day). Home BP measurement three times a day (9am; 3pm; 9pm) according to the standard protocol during the whole study period was used. Standard deviation (SD) of measured BPs was used to calculate BPV. Coefficient of variation was calculated in all the groups according to the salt intake amount. Results: Average SBPs, DBPs and SDs during regular, low and high salt intake were as follows: 152.4 mmHg vs 148.2 mmHg and 154.8 mmHg for SBP, 91.4 mmHg, 90.2 mmHg and 93.8 mmHg for DBP, respectively; SDs of SBP were 12.2 ± 4.2 vs 9.4 ± 3.8 vs 13.2 ± 3.5 for systolic and 6.4 ± 3.7 vs 6.3 ± 3 and 6.8 ± 3.3 for diastolic, respectively. Coefficient of variation of SBP for regular, low and high salt diets were 8 ± 2.7%, 6.3 ± 2.5% and 8.6 ± 2.3% and for DBP - 6.9 ± 4%, 7 ± 3.3% and 7.3 ± 3.5%, respectively. High salt diet significantly increased average SBP, DBP and SDs. Conclusion: Study data show, that high sodium diet leads to the higher average BP and BPV. Differences of SBP and DBP between the groups were higher than 2 mmHg. Framingham Heart Study showed that population wide reduction of DBP in 2 mmHg is associated with a 6% reduction in CHD risk and Lewington et al, in 2002 showed that SBP reduction in only 2 mmHg would lead to 7% reduction in the incidence of death secondary to stroke and 10% reduction in IHD. High BPV is considered as a strong indicator for CV events per

Impact of obstructive sleep apnea on long-term blood pressure variability in Japanese men: a cross-sectional study of a work-site population.

Blood pressure variability (BPV) has been shown to be associated with cardiovascular diseases. The effects on long-term BPV of obstructive sleep apnea (OSA) are not yet known. We evaluated a total of 1653 Japanese male workers (18-69 years) at a work site to diagnose OSA, and we divided them into three groups: non-OSA (apnea-hypopnea index (AHI): < 5, n = 1414), mild-to-moderate OSA (5 ≤ AHI < 30: n = 131) and severe OSA (AHI ≥ 30: n = 108). The standard deviation and coefficient of variation of the subjects' BPV were calculated by using their annual blood pressure measurements at routine physical examinations from 2012 to 2015 (four measurements). The multivariable-adjusted BPV of systolic blood pressure (SBP) was significantly higher in the severe-OSA group compared to the non-OSA group. A multiple regression analysis also revealed that OSA was positively associated with BPV of SBP. We focused on the mild-to-moderate OSA group to evaluate the association of OSA treatment with BPV, because most of the severe-OSA subjects were being treated with continuous positive airway pressure or an oral appliance. The BPV of both systolic and diastolic blood pressure was significantly decreased in the treated subjects. These findings suggest that OSA is associated with increases in long-term BPV which was improved by the treatment of OSA in Japanese men of a work-site population.

The association of interdialytic blood pressure variability with cardiovascular events and all-cause mortality in haemodialysis patients.

Long-term pre-dialysis blood pressure variability (BPV) in haemodialysis patients is associated with increased cardiovascular risk. The association of the main haemodynamic culprit in dialysis, that is, short-term BPV, with outcomes has not been investigated. We examine the prognostic role of short-term BPV for mortality and cardiovascular events in this population. A total of 227 haemodialysis patients underwent 44-h ambulatory monitoring during a standard interval and were followed-up for 30.17 ± 17.70 months. We calculated SD, weighted SD (wSD), coefficient of variation (CV) and average real variability (ARV) of BP with validated formulas. The primary endpoint was first occurrence of all-cause death, non-fatal myocardial infarction or non-fatal stroke. Secondary endpoints were: (i) all-cause mortality, (ii) cardiovascular mortality and (iii) a combination of cardiovascular events. Cumulative freedom from the primary endpoint was similar for quartiles of pre-dialysis and 44-h systolic BP (SBP), but was progressively longer for increasing quartiles of 44-h SBP-SD (P = 0.014), wSD (P = 0.007), CV (P = 0.031) and ARV (83.9, 71.9, 70.2 and 43.9% for quartiles 1-4; P < 0.001). Higher quartiles of 44-h SBP-ARV were associated with higher risk of all studied outcomes. Among diastolic BPV indices, 44-h diastolic BP (DBP)-CV and 44-h DBP-ARV were associated with increased risk for the composite cardiovascular outcome. In Cox regression analysis, SBP-BPV was related to the primary endpoint, independently of SBP levels and interdialytic weight gain [ARV: hazard ratio (HR) 1.115, 95% confidence interval (95% CI) 1.048-1.185]. This association become insignificant after adjustment for pulse wave velocity (PWV; HR 1.061, 95% CI 0.989-1.137), and further attenuated after additional adjustment for age, dialysis vintage, gender, comorbidities and prevalent cardiovascular disease (HR 1.031, 95% CI 0.946-1.122). Increased BPV during the interdialytic interval is associated with higher risk of death and cardiovascular events, whereas ambulatory BP levels are not. This association was not independent after adjustment for PWV, other risk factors and prevalent cardiovascular disease. Short-term BPV could be a mediator promoting the adverse cardiovascular profile of haemodialysis patients.

Long-Term Blood Pressure Level and Variability From Midlife to Later Life and Subsequent Cognitive Change: The ARIC Neurocognitive Study.

BackgroundTo understand how blood pressure (BP) from midlife and beyond is related to cognition in older age, a lifespan approach is needed. We assessed the associations of BP levels and variability from midlife on with subsequent cognitive change.Methods and ResultsThe ARIC (Atherosclerosis Risk in Communities) Study participants underwent 4 clinic BP measurements (visit 1, 2, 3, and 4 BPs) between 1987 and 1998, and their mean levels and average real variability (ARV) were assessed as exposures. A global cognitive z score, estimated from the Delayed Word Recall Test, Digit Symbol Substitution Test, and Word Fluency Test scores, was calculated at 1996 to 1998 (visit 4) and 2011 to 2013 (visit 5). Among 11 408 participants (mean age, 54 years; 56% women; 21% black race), mean systolic BP (SBP)/diastolic BP (DBP) level was 123/72 mm Hg, and ARVSBP/ARVDBP was 11/7 mm Hg. With linear mixed models, 1‐SD increases of ARVSBP (standardized regression coefficient [95% confidence interval], −0.03 [−0.04 to −0.01] points) and ARVDBP (standardized regression coefficient [95% confidence interval], −0.02 [−0.03 to −0.002] points; both P<0.05), but not mean SBP or DBP levels, were associated with lower global cognitive z scores at visit 4. In contrast, mean SBP (standardized regression coefficient [95% confidence interval], −0.04 [−0.06 to −0.02] points) or DBP (standardized regression coefficient [95% confidence interval], 0.04 [0.02–0.06] points; both P<0.001) level, but not ARVSBP or ARVDBP, was associated with change in global cognitive z scores from visits 4 to 5.ConclusionsGreater visit‐to‐visit SBP or DBP variability from midlife on is modestly associated with lower cognitive function, whereas higher mean SBP and lower DBP levels from midlife to later life are modestly associated with cognitive decline in later life.

Peak lung function during young adulthood and future long-term blood pressure variability: The Coronary Artery Risk Development in Young Adults (CARDIA) study

Background and aimsLong-term blood pressure variability (BPV) is associated with cardiovascular events independent of mean blood pressure (BP); however, little is known about its predictors. MethodsUsing data from the CARDIA study, we investigated the association between peak lung-function and long-term BPV in 2917 individuals (mean age 24.8 years, 45.3% males, 58.6% whites) who were not taking antihypertensive medications. Lung-function was measured using forced vital capacity (FVC) and forced expiratory volume in 1-s (FEV1) at years 0, 2, 5, 10 and 20 and the maximum score attained was considered as peak lung-function. Variability independent of the mean (VIM) and coefficient of variation (CV) of BP were calculated to quantify BPV since achieving peak lung-function across 9 visits over 30 years. ResultsIn a multivariate linear regression models, individuals in the 2nd (−0.64 mmHg; 95% CI: −1.06, −0.19), 3rd (−0.96; −1.47, −0.45), and 4th (−0.85: −1.53, −0.17) quartiles of FVC had lower VIM of systolic BP than the those in quartile 1 (p-trend = 0.005). CV of systolic BP was also lower by −0.58 (−0.98, −0.19), −0.92 (−1.42, −0.43), and −0.74 (−1.40, −0.08) percentage points, in the three progressively higher quartiles of FVC compared to quartile 1 (p-trend = 0.008). Similar findings were observed when the outcome was diastolic BPV. There was no association of FEV1 and FEV1-to-FVC ratio with BPV. ConclusionsThese findings suggest that smaller lung volume or restrictive lung disease during young adulthood, which result in lower peak FVC, may independently increase the risk of higher long-term BPV during middle adulthood.

Visit-to-visit (long-term) and ambulatory (short-term) blood pressure variability to predict mortality in an elderly hypertensive population.

To explore the association of different types of blood pressure (BP) variability measures estimated from either short-term ambulatory reading-to-reading or long-term clinic visit-to-visit BP records with long-term survival in an elderly treated hypertensive population. A subset of patients (n = 508) aged at least 65-years was studied from the Second Australian National Blood Pressure study. We estimated SBP and DBP BP variability as the SD of ambulatory (24-h, daytime, night-time) and clinic visit-to-visit BP directly from all corresponding on-treatment within-individual BP records. Ambulatory 'weighted day-night' variability was calculated as a weighted mean of daytime and night-time SD. Cox-proportional hazard models adjusted for baseline risk factors (Model 1) and corresponding on-treatment BP (Model 2) or average night-time SBP (best predictive BP measure for outcome) (Model 3) were used to determine the relationship between long-term outcome and BP variability. Over a median of 10.6 years, 101 patients died from any cause, of which 51 deaths were cardiovascular. We observed increase in 'daytime' and 'weighted day-night' SBP/DBP variability was significantly associated with increased all-cause mortality in all models. For cardiovascular mortality, only 'weighted day-night' SBP variability significantly predicted risk in all models (Model 3 hazard ratio: 1.09, 95% confidence interval: 1.00-1.19, P = 0.04). Long-term BP variability was not associated with any outcome. On direct comparison, both 'daytime' and 'weighted day-night' BP variability measures provided similar prognostic information. Short-term 'daytime' and 'weighted day-night' SBP variability from ambulatory BP recordings was a better predictor of mortality in elderly treated hypertensive patients than long-term BP variability from visit-to-visit BP recordings.

Methodological factors affecting quantification of blood pressure variability: a scoping review.

Blood pressure (BP) variability (BPV) may offer independent prognostic information. However, data supporting this notion are inconsistent, and this may be due to the wide variety of methodologies used for measuring BPV. A systematic analysis on the effect of BPV methodologies on BPV itself has never been undertaken and was the aim of this study. We also sought to determine the effect of participant characteristics on BPV. A scoping review process was used to identify the effect of BPV methodologies on BPV magnitude. Key methodological factors assessed were the number of BP readings or visits used to quantify BPV and the duration of BP monitoring. In addition, the relationship between age and mean BP level on BPV was investigated. Analyses were performed across studies that measured BPV over the short-term (using 24-h BP), mid-term (using home BP in the morning, evening or day-to-day) and long-term (using visit-to-visit clinic BP). Data were extracted from 96 studies. The number of BP readings and visits used to quantify BPV were positively associated with mid-term and long-term BPV. Duration was weakly associated with mid-term (morning) BPV. Age was positively associated with long-term and mid-term (day-to-day), but not short-term BPV. Mean BP level was positively associated with BPV, except mid-term BPV (morning and evening). The methodology used to quantify BPV, as well as age and mean BP level, affects the magnitude of BPV itself. This highlights the need to standardize BPV protocols, particularly regarding the number of BP readings and visits.

Abstract P175: Predictors of Long Term Blood Pressure Variability in Young Adulthood Through Middle Age: The Coronary Artery Risk Development in Young Adults Study

Introduction: Long-term blood pressure variability (BPV) refers to fluctuation in BP that occur over weeks, months and years. BPV has been identified as a risk factor for the development of subclinical and clinical cardiovascular events independent of mean BP. However, little is known about the factors associated with long-term BPV. We hypothesized that long-term BPV will vary by demographic, behavioral, anthropometric, lab, and clinical factors. Methods: Using data from the CARDIA study – a longitudinal population based cohort study, we investigated whether baseline demographics (age, sex, race, education); behavioral factors (smoking, alcohol intake, physical activity); anthropometric measures (height, weight, body mass index - BMI); lab markers (total cholesterol, high density lipoprotein cholesterol - HDL-C, low density lipoprotein cholesterol – LDL-C, triglycerides, fasting blood glucose, glomerular filtration rate - GFR); and history of asthma are associated with different indictors of long-term BPV. Variability independent of the mean (VIM) and coefficient of variation (CV) of BP were calculated to quantify within-individual long-term BPV from baseline to visit 9 across 30 years. A least absolute shrinkage and selection operator (lasso) linear regression was used to identify variables that may be associated with long-term BPV and multivariate linear regression models were used to assess magnitude of association. Results: Participants were 3,095 individuals who were not taking antihypertensive medication (mean age 24.6 years, 45.5% male and 56.9% white). Mean VIM was 8.5 mmHg (SD=3.7) for systolic and 7.1 mmHg (SD=3.2) for diastolic BP. Age, sex, race, education, physical activity, alcohol intake, pack-years of smoking, height, weight, triglyceride, LDL-C and asthma were potential correlates of VIM or CV of diastolic BP by the lasso model. In addition to those variables, total cholesterol, HDL-C, fasting glucose, and GFR were potential correlates of VIM or CV of systolic BP. Variables that significantly associated with VIM of systolic BP were: age (years) (β=0.11, p&lt;0.001), white race (β= -0.94, p&lt;0.001), female sex (β=1.36, p&lt;0.001), alcohol intake (drinks/wk) (β=0.01, p=0.001), height (cm) (β= -0.03, p=0.001), and history asthma (β=-0.47, p=0.02). Consistent findings were observed when the outcome was CV of systolic BP. VIM of diastolic BP was also significantly associated with age (β= -0.09, p&lt;0.001) white race (β= -0.47, p=0.26), pack-years (β=0.06, p&lt;0.001), height (cm) (β= -0.03, p&lt;0.001), and history asthma (β=-0.47, p=0.01). The same variables were significantly associated with CV of diastolic BP. Conclusion: Identifying factors associated with long-term BPV can be useful to detect individuals who may be at a greater risk for future higher long-term BPV, which in turn is associated with greater cardiovascular risk.

Effect of premature birth on long-term systolic blood pressure variability in women.

Objective:To investigate the effect of premature birth (PTB) on long-term systolic blood pressure (SBP) variability (SBPV) in women.Methods:A total of 1974 pregnant women were divided into PTB group and non-PTB (NPTB) group. The SBP standard deviation (SSD) was calculated by four annual SBP values measured in 2006–2007, 2008–2009, 2010–2011, and 2012–2013. SBP coefficient of variation (SCV) was calculated by dividing SSD with mean SBP. Multivariate logistic regression analysis was used to analyze the influence of PTB on long-time SSD and SCV in women.Results:SSD and SCV of the PTB group (10.95 mm Hg and 9.05%, respectively) were higher than those of the NPTB group (9.81 mm Hg and 8.23%, respectively), but there were no significant differences (p>0.05). The number of patients with SSD >9.87 mm Hg and SCV >8.28% in the PTB and NPTB groups was 57 (51.40%) and 62 (55.90%) and 747 (40.10%) and 841 (45.10%), respectively. The number of patients with SSD >9.87 mm Hg and SCV >8.28% in the PTB group was significantly higher than that in the NPTB group (p<0.05). Multiple logistic regression analysis showed that after adjusting other risk factors, the PTB group was at a risk of SSD and SCV elevations with OR values of 1.60 (95% CI: 1.06–2.40) and 1.64 (95% CI: 1.10–2.45), respectively.Conclusion:PTB is a risk factor of long-time SBPV in women, which might be a potential reason for cardiovascular events. Pregnancy may be an important opportunity for early identification of women at an increased risk of cardiovascular disease later in life.