Prognostic value of reading-to-reading blood pressure variability over 24 hours in 8938 subjects from 11 populations

Tine W Hansen; Lutgarde Thijs; Yan Li; José Boggia; Masahiro Kikuya; Kristina Björklund-Bodegård; Tom Richart; Takayoshi Ohkubo; Jørgen Lykke Jeppesen; Christian Torp-Pedersen; Eamon Dolan; Tatiana Kuznetsova; Katarzyna Stolarz-Skrzypek; Valérie Tikhonoff; Sofia Malyutina; Edoardo Casiglia; Yuri Nikitin; Lars Solskov Lind; Edgardo Sandoya; Kalina Kawecka-Jaszcz; Yutaka Imai; Jiguang Wang; Hans Ibsen; Eoin O'Brien; Jan A Staessen; International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcomes Investigators; Yan Li

doi:http://dx.doi.org/10.1161/HYPERTENSIONAHA.109.140798

Prognostic value of reading-to-reading blood pressure variability over 24 hours in 8938 subjects from 11 populations

Tine W Hansen, Lutgarde Thijs, Yan Li, José Boggia, Masahiro Kikuya, Kristina Björklund-Bodegård, Tom Richart, Takayoshi Ohkubo, Jørgen Lykke Jeppesen, Christian Torp-Pedersen, Eamon Dolan, Tatiana Kuznetsova, Katarzyna Stolarz-Skrzypek, Valérie Tikhonoff, Sofia Malyutina, Edoardo Casiglia, Yuri Nikitin, Lars Solskov Lind, Edgardo Sandoya, Kalina Kawecka-JaszczYutaka Imai, Jiguang Wang, Hans Ibsen, Eoin O'Brien, Jan A Staessen, International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcomes Investigators, Yan Li

304 Citations (Scopus)

Abstract

In previous studies, of which several were underpowered, the relation between cardiovascular outcome and blood pressure (BP) variability was inconsistent. We followed health outcomes in 8938 subjects (mean age: 53.0 years; 46.8% women) randomly recruited from 11 populations. At baseline, we assessed BP variability from the SD and average real variability in 24-hour ambulatory BP recordings. We computed standardized hazard ratios (HRs) while stratifying by cohort and adjusting for 24-hour BP and other risk factors. Over 11.3 years (median), 1242 deaths (487 cardiovascular) occurred, and 1049, 577, 421, and 457 participants experienced a fatal or nonfatal cardiovascular, cardiac, or coronary event or a stroke. Higher diastolic average real variability in 24-hour ambulatory BP recordings predicted (P≤0.03) total (HR: 1.14) and cardiovascular (HR: 1.21) mortality and all types of fatal combined with nonfatal end points (HR: ≥1.07) with the exception of cardiac and coronary events (HR: ≤1.02; P≥0.58). Higher systolic average real variability in 24-hour ambulatory BP recordings predicted (P<0.05) total (HR: 1.11) and cardiovascular (HR: 1.16) mortality and all fatal combined with nonfatal end points (HR: ≥1.07), with the exception of cardiac and coronary events (HR: ≤1.03; P≥0.54). SD predicted only total and cardiovascular mortality. While accounting for the 24-hour BP level, average real variability in 24-hour ambulatory BP recordings added <1% to the prediction of a cardiovascular event. Sensitivity analyses considering ethnicity, sex, age, previous cardiovascular disease, antihypertensive treatment, number of BP readings per recording, or the night:day BP ratio were confirmatory. In conclusion, in a large population cohort, which provided sufficient statistical power, BP variability assessed from 24-hour ambulatory recordings did not contribute much to risk stratification over and beyond 24-hour BP.

Original language	English
Journal	Hypertension
Volume	55
Issue number	4
Pages (from-to)	1049-57
Number of pages	9
DOIs	https://doi.org/10.1161/HYPERTENSIONAHA.109.140798
Publication status	Published - 1 Apr 2010

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Hansen, T. W., Thijs, L., Li, Y., Boggia, J., Kikuya, M., Björklund-Bodegård, K., Richart, T., Ohkubo, T., Jeppesen, J. L., Torp-Pedersen, C., Dolan, E., Kuznetsova, T., Stolarz-Skrzypek, K., Tikhonoff, V., Malyutina, S., Casiglia, E., Nikitin, Y., Lind, L. S., Sandoya, E., ... Li, Y. (2010). Prognostic value of reading-to-reading blood pressure variability over 24 hours in 8938 subjects from 11 populations. Hypertension, 55(4), 1049-57. https://doi.org/10.1161/HYPERTENSIONAHA.109.140798

Hansen, TW, Thijs, L, Li, Y, Boggia, J, Kikuya, M, Björklund-Bodegård, K, Richart, T, Ohkubo, T, Jeppesen, JL, Torp-Pedersen, C, Dolan, E, Kuznetsova, T, Stolarz-Skrzypek, K, Tikhonoff, V, Malyutina, S, Casiglia, E, Nikitin, Y, Lind, LS, Sandoya, E, Kawecka-Jaszcz, K, Imai, Y, Wang, J, Ibsen, H, O'Brien, E, Staessen, JA, International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcomes Investigators & Li, Y 2010, 'Prognostic value of reading-to-reading blood pressure variability over 24 hours in 8938 subjects from 11 populations', Hypertension, vol. 55, no. 4, pp. 1049-57. https://doi.org/10.1161/HYPERTENSIONAHA.109.140798

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title = "Prognostic value of reading-to-reading blood pressure variability over 24 hours in 8938 subjects from 11 populations",

abstract = "In previous studies, of which several were underpowered, the relation between cardiovascular outcome and blood pressure (BP) variability was inconsistent. We followed health outcomes in 8938 subjects (mean age: 53.0 years; 46.8% women) randomly recruited from 11 populations. At baseline, we assessed BP variability from the SD and average real variability in 24-hour ambulatory BP recordings. We computed standardized hazard ratios (HRs) while stratifying by cohort and adjusting for 24-hour BP and other risk factors. Over 11.3 years (median), 1242 deaths (487 cardiovascular) occurred, and 1049, 577, 421, and 457 participants experienced a fatal or nonfatal cardiovascular, cardiac, or coronary event or a stroke. Higher diastolic average real variability in 24-hour ambulatory BP recordings predicted (P≤0.03) total (HR: 1.14) and cardiovascular (HR: 1.21) mortality and all types of fatal combined with nonfatal end points (HR: ≥1.07) with the exception of cardiac and coronary events (HR: ≤1.02; P≥0.58). Higher systolic average real variability in 24-hour ambulatory BP recordings predicted (P<0.05) total (HR: 1.11) and cardiovascular (HR: 1.16) mortality and all fatal combined with nonfatal end points (HR: ≥1.07), with the exception of cardiac and coronary events (HR: ≤1.03; P≥0.54). SD predicted only total and cardiovascular mortality. While accounting for the 24-hour BP level, average real variability in 24-hour ambulatory BP recordings added <1% to the prediction of a cardiovascular event. Sensitivity analyses considering ethnicity, sex, age, previous cardiovascular disease, antihypertensive treatment, number of BP readings per recording, or the night:day BP ratio were confirmatory. In conclusion, in a large population cohort, which provided sufficient statistical power, BP variability assessed from 24-hour ambulatory recordings did not contribute much to risk stratification over and beyond 24-hour BP.",

author = "Hansen, {Tine W} and Lutgarde Thijs and Yan Li and Jos{\'e} Boggia and Masahiro Kikuya and Kristina Bj{\"o}rklund-Bodeg{\aa}rd and Tom Richart and Takayoshi Ohkubo and Jeppesen, {J{\o}rgen Lykke} and Christian Torp-Pedersen and Eamon Dolan and Tatiana Kuznetsova and Katarzyna Stolarz-Skrzypek and Val{\'e}rie Tikhonoff and Sofia Malyutina and Edoardo Casiglia and Yuri Nikitin and Lind, {Lars Solskov} and Edgardo Sandoya and Kalina Kawecka-Jaszcz and Yutaka Imai and Jiguang Wang and Hans Ibsen and Eoin O'Brien and Staessen, {Jan A} and Torp-Pedersen, {Christian Tobias} and Yan Li",

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T1 - Prognostic value of reading-to-reading blood pressure variability over 24 hours in 8938 subjects from 11 populations

AU - Hansen, Tine W

AU - Thijs, Lutgarde

AU - Li, Yan

AU - Boggia, José

AU - Kikuya, Masahiro

AU - Björklund-Bodegård, Kristina

AU - Richart, Tom

AU - Ohkubo, Takayoshi

AU - Jeppesen, Jørgen Lykke

AU - Torp-Pedersen, Christian

AU - Dolan, Eamon

AU - Kuznetsova, Tatiana

AU - Stolarz-Skrzypek, Katarzyna

AU - Tikhonoff, Valérie

AU - Malyutina, Sofia

AU - Casiglia, Edoardo

AU - Nikitin, Yuri

AU - Lind, Lars Solskov

AU - Sandoya, Edgardo

AU - Kawecka-Jaszcz, Kalina

AU - Imai, Yutaka

AU - Wang, Jiguang

AU - Ibsen, Hans

AU - O'Brien, Eoin

AU - Staessen, Jan A

AU - International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcomes Investigators

AU - Li, Yan

PY - 2010/4/1

Y1 - 2010/4/1

N2 - In previous studies, of which several were underpowered, the relation between cardiovascular outcome and blood pressure (BP) variability was inconsistent. We followed health outcomes in 8938 subjects (mean age: 53.0 years; 46.8% women) randomly recruited from 11 populations. At baseline, we assessed BP variability from the SD and average real variability in 24-hour ambulatory BP recordings. We computed standardized hazard ratios (HRs) while stratifying by cohort and adjusting for 24-hour BP and other risk factors. Over 11.3 years (median), 1242 deaths (487 cardiovascular) occurred, and 1049, 577, 421, and 457 participants experienced a fatal or nonfatal cardiovascular, cardiac, or coronary event or a stroke. Higher diastolic average real variability in 24-hour ambulatory BP recordings predicted (P≤0.03) total (HR: 1.14) and cardiovascular (HR: 1.21) mortality and all types of fatal combined with nonfatal end points (HR: ≥1.07) with the exception of cardiac and coronary events (HR: ≤1.02; P≥0.58). Higher systolic average real variability in 24-hour ambulatory BP recordings predicted (P<0.05) total (HR: 1.11) and cardiovascular (HR: 1.16) mortality and all fatal combined with nonfatal end points (HR: ≥1.07), with the exception of cardiac and coronary events (HR: ≤1.03; P≥0.54). SD predicted only total and cardiovascular mortality. While accounting for the 24-hour BP level, average real variability in 24-hour ambulatory BP recordings added <1% to the prediction of a cardiovascular event. Sensitivity analyses considering ethnicity, sex, age, previous cardiovascular disease, antihypertensive treatment, number of BP readings per recording, or the night:day BP ratio were confirmatory. In conclusion, in a large population cohort, which provided sufficient statistical power, BP variability assessed from 24-hour ambulatory recordings did not contribute much to risk stratification over and beyond 24-hour BP.

AB - In previous studies, of which several were underpowered, the relation between cardiovascular outcome and blood pressure (BP) variability was inconsistent. We followed health outcomes in 8938 subjects (mean age: 53.0 years; 46.8% women) randomly recruited from 11 populations. At baseline, we assessed BP variability from the SD and average real variability in 24-hour ambulatory BP recordings. We computed standardized hazard ratios (HRs) while stratifying by cohort and adjusting for 24-hour BP and other risk factors. Over 11.3 years (median), 1242 deaths (487 cardiovascular) occurred, and 1049, 577, 421, and 457 participants experienced a fatal or nonfatal cardiovascular, cardiac, or coronary event or a stroke. Higher diastolic average real variability in 24-hour ambulatory BP recordings predicted (P≤0.03) total (HR: 1.14) and cardiovascular (HR: 1.21) mortality and all types of fatal combined with nonfatal end points (HR: ≥1.07) with the exception of cardiac and coronary events (HR: ≤1.02; P≥0.58). Higher systolic average real variability in 24-hour ambulatory BP recordings predicted (P<0.05) total (HR: 1.11) and cardiovascular (HR: 1.16) mortality and all fatal combined with nonfatal end points (HR: ≥1.07), with the exception of cardiac and coronary events (HR: ≤1.03; P≥0.54). SD predicted only total and cardiovascular mortality. While accounting for the 24-hour BP level, average real variability in 24-hour ambulatory BP recordings added <1% to the prediction of a cardiovascular event. Sensitivity analyses considering ethnicity, sex, age, previous cardiovascular disease, antihypertensive treatment, number of BP readings per recording, or the night:day BP ratio were confirmatory. In conclusion, in a large population cohort, which provided sufficient statistical power, BP variability assessed from 24-hour ambulatory recordings did not contribute much to risk stratification over and beyond 24-hour BP.

U2 - http://dx.doi.org/10.1161/HYPERTENSIONAHA.109.140798

DO - http://dx.doi.org/10.1161/HYPERTENSIONAHA.109.140798

M3 - Journal article

SN - 0194-911X

VL - 55

SP - 1049

EP - 1057

JO - Hypertension

JF - Hypertension

IS - 4

ER -

Prognostic value of reading-to-reading blood pressure variability over 24 hours in 8938 subjects from 11 populations

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