Visit-to-Visit Blood Pressure Variability and Mortality and Cardiovascular Outcomes Among Older Adults: The Health, Aging, and Body Composition Study

Am J Hypertens. 2017 Feb;30(2):151-158. doi: 10.1093/ajh/hpw106. Epub 2016 Sep 6.

Abstract

Background: Level of blood pressure (BP) is strongly associated with cardiovascular (CV) events and mortality. However, it is questionable whether mean BP can fully capture BP-related vascular risk. Increasing attention has been given to the value of visit-to-visit BP variability.

Methods: We examined the association of visit-to-visit BP variability with mortality, incident myocardial infarction (MI), and incident stroke among 1,877 well-functioning elders in the Health, Aging, and Body Composition Study. We defined visit-to-visit diastolic BP (DBP) and systolic BP (SBP) variability as the root-mean-square error of person-specific linear regression of BP as a function of time. Alternatively, we counted the number of considerable BP increases and decreases (separately; 10mm Hg for DBP and 20mm Hg for SBP) between consecutive visits for each individual.

Results: Over an average follow-up of 8.5 years, 623 deaths (207 from CV disease), 153 MIs, and 156 strokes occurred. The median visit-to-visit DBP and SBP variability was 4.96 mmHg and 8.53 mmHg, respectively. After multivariable adjustment, visit-to-visit DBP variability was related to higher all-cause (hazard ratio (HR) = 1.18 per 1 SD, 95% confidence interval (CI) = 1.01-1.37) and CV mortality (HR = 1.35, 95% CI = 1.05-1.73). Additionally, individuals having more considerable decreases of DBP (≥10mm Hg between 2 consecutive visits) had higher risk of all-cause (HR = 1.13, 95% CI = 0.99-1.28) and CV mortality (HR = 1.30, 95% CI = 1.05-1.61); considerable increases of SBP (≥20mm Hg) were associated with higher risk of all-cause (HR = 1.18, 95% CI = 1.03-1.36) and CV mortality (HR = 1.37, 95% CI = 1.08-1.74).

Conclusions: Visit-to-visit DBP variability and considerable changes in DBP and SBP were risk factors for mortality in the elderly.

Keywords: aged.; blood pressure; blood pressure variability; hypertension; mortality; myocardial infarction; stroke.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Aging*
  • Blood Pressure / physiology*
  • Blood Pressure Determination
  • Body Composition*
  • California / epidemiology
  • Cohort Studies
  • Female
  • Health Status*
  • Humans
  • Hypertension / complications
  • Hypertension / physiopathology*
  • Incidence
  • Longitudinal Studies
  • Male
  • Myocardial Infarction / epidemiology*
  • Myocardial Infarction / etiology
  • Myocardial Infarction / physiopathology
  • Office Visits
  • Prognosis
  • Retrospective Studies
  • Risk Factors
  • Stroke / epidemiology*
  • Stroke / etiology
  • Stroke / physiopathology
  • Survival Rate / trends