Association of blood pressure variability with CV risk is irrespective of CV baseline risk
Blood pressure variability and risk of cardiovascular events and death in patients with hypertension and different baseline risksLiterature - Mehlum MH, Liestøl K, Kjeldsen SE, et al. - Eur Heart J 2018; published online ahead of print
- During a mean follow-up of 4.0 years (SD: 0.8 years), 11.3% of patients had a CV event, 8.6% had a cardiac event, 3.2% a stroke and 0.6% had both a cardiac event and stroke.
- Compared to patients with the lowest variability, those in the highest quintile of SD had an increased risk of a CV event (HR: 2.1; 95%CI: 1.7–2.4; P<0.0001). The risks of cardiac events and stroke were both increased (HR: 2.3, 95% CI:1.9–2.8; P<0.0001 and HR: 1.5, 95% CI 1.1–2.1; P=0.008, respectively) as were the risks of myocardial infarction (HR: 3.2, 95% CI 2.3–4.3; P<0.0001), congestive heart failure (HR: 3.1, 95% CI 2.2–4.3; P<0.0001), and ischemic stroke (HR: 1.9, 95% CI: 1.3–2.7; P<0.0001), but not hemorrhagic stroke (HR; 0.6, 95% CI: 0.3–1.5; P=0.3).
- In sensitivity analyses, results were the same, except that the association for stroke was not statistically significant in the per-protocol population.
- The association between visit-to-visit BP variability and CV events was similar in patients at moderate and very high risk (P for interaction=0.4).
- There was a significantly increased risk of death (HR: 1.10; 95%CI: 1.04–1.17; P=0.002), equivalent to a 10% increase in risk for 5 mmHg increase in SD of visit-to-visit SBP.
- Subgroup analyses showed that the association was stronger for younger patients (P for interaction=0.02), and for patients with established CV disease (P for interaction=0.04), as well as for patients with lower BP (P<0.0001).
Patients with hypertension and higher BP variability are at increased risk of CV events as compared with those with low BP variability, irrespective of CV baseline risk. The association is stronger in younger patients, and those with a lower BP.