Wide variations in blood pressure linked to CVD and death
Data from ALLHAT showed a strong association between wide fluctuations in systolic blood pressure and fatal coronary heart disease or nonfatal myocardial infarction, all-cause mortality, stroke, and heart failure.
Higher variability of systolic blood pressure readings between outpatient visits is associated with an increased risk for cardiovascular disease (CVD) and mortality independent of the overall degree of blood pressure control, a study found.
To examine the association of visit-to-visit variability (VVV) of systolic blood pressure and diastolic blood pressure with CVD and mortality outcomes, researchers conducted a post hoc analysis of 25,814 participants in ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial).
Variability of systolic blood pressure was defined as the standard deviation across systolic blood pressure measurements obtained at 7 visits conducted from 6 to 28 months after ALLHAT enrollment. Participants without CVD events during the first 28 months of follow-up were followed from the 28-month visit through the end of active ALLHAT follow-up. Outcomes included fatal coronary heart disease (CHD) or nonfatal myocardial infarction (MI), all-cause mortality, stroke, and heart failure.
Results were published online July 28 by Annals of Internal Medicine.
During follow-up, there were 1,194 fatal CHD or nonfatal MI events, 1,948 deaths, 606 strokes, and 921 heart failure events. The data showed a strong association between wide fluctuations in systolic blood pressure and fatal coronary heart disease or nonfatal myocardial infarction, all-cause mortality, stroke, and heart failure. After multivariable adjustment, including for mean systolic blood pressure, the hazard ratio for participants in the highest versus lowest quintile of SD of variation (≥14.4 mm Hg vs. <6.5 mm Hg) was 1.30 (95% CI, 1.06 to 1.59) for fatal CHD or nonfatal MI, 1.58 (95% CI, 1.32 to 1.90) for all-cause mortality, 1.46 (95% CI, 1.06 to 2.01) for stroke, and 1.25 (95% CI, 0.97 to 1.61) for heart failure.
More study is needed, the authors noted.
“We note the potential utility of clarifying the prognostic value of VVV of BP among hypertensive persons,” they wrote. “Although antihypertensive treatment reduces the risk for mortality and CVD outcomes, hypertensive persons with controlled BP continue to have measureable excess risk. Novel therapies or drug combinations addressing VVV of BP might further reduce this excess risk. Studies of the association between VVV of BP and CVD outcomes may also help in understanding the mechanistic links between hypertension and CVD, which can lead to more efficacious therapy.”