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  • Special Issue: Current evidence and perspectives for hypertension management in Asia
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Visit-to-visit blood pressure variability and the risk of cardiovascular disease: a prospective cohort analysis

Hypertension Research volume 46, pages 2622–2634 (2023)Cite this article

Abstract

Large blood pressure (BP) variability contributed to subclinical brain disease thus may be implicated in the development of cardiovascular disease (CVD). This study included 64,810 CVD-free participants who attended the first two examinations from the Kailuan study to investigate the association of BP variation, considering its magnitude, direction, and time interval prior to CVD diagnosis, with the risk of CVD in Chinese population. Magnitude and directional BP variability was calculated as absolute BP difference or BP difference value divided by mean BP over 2 sequential visits, respectively. During a median follow-up of 10.91 years, a total of 4129 cases of CVD. A large SBP variability (the highest vs the lowest tertile) was associated with a higher risk of CVD (adjusted HR, 1.31; 95% CI, 1.22–1.41). The associations were stronger with longer time intervals, the hazard ratio (HR) with 95% confidence interval (CI) for CVD was 1.30 (95% CI, 1.20–1.39) at 1 years, 1.32 (1.18–1.40) at 3 years, and 1.34 (1.20–1.45) at 5 years. For directional SBP variability, rise in SBP was associated with an increased risk of CVD (HR, 6.17; 95% CI, 5.65–6.75), while fall in SBP was associated with a decreased risk of CVD (HR, 0.52; 95% CI, 0.46–0.59). Subgroup analysis showed the significant associations were only observed in men (Pint = 0.0010). Similar patterns were observed for DBP variability and CVD subtypes. The results indicated that a large SBP variation in rise direction was associated with an increased risk of incident CVD, especially in men.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Lawes CM, Vander Hoorn S, Rodgers A. Global burden of blood-pressure-related disease, 2001. Lancet (Lond, Engl). 2008;371:1513–8.

    Article  Google Scholar 

  2. Grassi G, Bombelli M, Brambilla G, Trevano FQ, Dell'oro R, Mancia G. Total cardiovascular risk, blood pressure variability and adrenergic overdrive in hypertension: evidence, mechanisms and clinical implications. Curr Hypertens Rep. 2012;14:333–8.

    Article  PubMed  Google Scholar 

  3. Muller M, Sigurdsson S, Kjartansson O, Aspelund T, Lopez OL, Jonnson PV, et al. Joint effect of mid- and late-life blood pressure on the brain: the AGES-Reykjavik study. Neurology. 2014;82:2187–95.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Debette S, Schilling S, Duperron MG, Larsson SC, Markus HS. Clinical significance of magnetic resonance imaging markers of vascular brain injury: a systematic review and meta-analysis. JAMA Neurol. 2019;76:81–94.

    Article  PubMed  Google Scholar 

  5. Björklund K, Lind L, Zethelius B, Berglund L, Lithell H. Prognostic significance of 24-h ambulatory blood pressure characteristics for cardiovascular morbidity in a population of elderly men. J Hypertens. 2004;22:1691–7.

    Article  PubMed  Google Scholar 

  6. Gavish B, Ben-Dov IZ, Kark JD, Mekler J, Bursztyn M. The association of a simple blood pressure-independent parameter derived from ambulatory blood pressure variability with short-term mortality. Hypertens Res. 2009;32:488–95.

    Article  PubMed  Google Scholar 

  7. Stevens SL, Wood S, Koshiaris C, Law K, Glasziou P, Stevens RJ, et al. Blood pressure variability and cardiovascular disease: systematic review and meta-analysis. BMJ (Clin Res ed). 2016;354:i4098.

    Google Scholar 

  8. O'Brien E, Asmar R, Beilin L, Imai Y, Mancia G, Mengden T, et al. Practice guidelines of the European Society of Hypertension for clinic, ambulatory and self blood pressure measurement. J Hypertens. 2005;23:697–701.

    Article  CAS  PubMed  Google Scholar 

  9. Parati G, Stergiou GS, Asmar R, Bilo G, de Leeuw P, Imai Y, et al. European Society of Hypertension guidelines for blood pressure monitoring at home: a summary report of the Second International Consensus Conference on Home Blood Pressure Monitoring. J Hypertens. 2008;26:1505–26.

    Article  CAS  Google Scholar 

  10. Hata J, Arima H, Rothwell PM, Woodward M, Zoungas S, Anderson C, et al. Effects of visit-to-visit variability in systolic blood pressure on macrovascular and microvascular complications in patients with type 2 diabetes mellitus: the ADVANCE trial. Circulation. 2013;128:1325–34.

    Article  PubMed  Google Scholar 

  11. Muntner P, Whittle J, Lynch AI, Colantonio LD, Simpson LM, Einhorn PT, et al. Visit-to-visit variability of blood pressure and coronary heart disease, stroke, heart failure, and mortality: a cohort study. Ann Intern Med. 2015;163:329–38.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Jhee JH, Seo J, Lee CJ, Park JT, Han SH, Kang SW, et al. Ambulatory blood pressure variability and risk of cardiovascular events, all-cause mortality, and progression of kidney disease. J Hypertens. 2020;38:1712–21.

    Article  CAS  Google Scholar 

  13. Suchy-Dicey AM, Wallace ER, Mitchell SV, Aguilar M, Gottesman RF, Rice K, et al. Blood pressure variability and the risk of all-cause mortality, incident myocardial infarction, and incident stroke in the cardiovascular health study. Am J Hypertens. 2013;26:1210–7.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Tully PJ, Debette S, Dartigues JF, Helmer C, Artero S, Tzourio C. Antihypertensive drug use, blood pressure variability, and incident stroke risk in older adults: three-city cohort study. Stroke. 2016;47:1194–1200.

    Article  CAS  PubMed  Google Scholar 

  15. Chowdhury EK, Owen A, Krum H, Wing LM, Nelson MR, Reid CM. Systolic blood pressure variability is an important predictor of cardiovascular outcomes in elderly hypertensive patients. J Hypertens. 2014;32:525–33.

    Article  CAS  Google Scholar 

  16. Wang C, Yuan Y, Zheng M, Pan A, Wang M, Zhao M, et al. Association of age of onset of hypertension with cardiovascular diseases and mortality. J Am Coll Cardiol. 2020;75:2921–30.

    Article  PubMed  Google Scholar 

  17. Jin C, Chen S, Vaidya A, Wu Y, Wu Z, Hu FB, et al. Longitudinal change in fasting blood glucose and myocardial infarction risk in a population without diabetes. Diabetes Care. 2017;40:1565–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Wu S, An S, Li W, Lichtenstein AH, Gao J, Kris-Etherton PM, et al. Association of trajectory of cardiovascular health score and incident cardiovascular disease. JAMA Netw Open. 2019;2:e194758.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Heshmatollah A, Ma Y, Fani L, Koudstaal PJ, Ikram MA, Ikram MK. Visit-to-visit blood pressure variability and the risk of stroke in the Netherlands: a population-based cohort study. PLoS Med. 2022;19:e1003942.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Ma Y, Wolters FJ, Chibnik LB, Licher S, Ikram MA, Hofman A, et al. Variation in blood pressure and long-term risk of dementia: A population-based cohort study. PLoS Med. 2019;16:e1002933.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Ma Y, Yilmaz P, Bos D, Blacker D, Viswanathan A, Ikram MA, et al. Blood pressure variation and subclinical brain disease. J Am Coll Cardiol. 2020;75:2387–99.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Zhao M, Song L, Sun L, Wang M, Wang C, Yao S, et al. Associations of type 2 diabetes onset age with cardiovascular disease and mortality: The Kailuan study. Diabetes Care. 2021;44:1426–32.

    Article  PubMed Central  Google Scholar 

  23. Stroke-1989. Recommendations on stroke prevention, diagnosis, and therapy. Report of the WHO task force on stroke and other cerebrovascular disorders. Stroke 1989; 20:1407-31.

  24. Tunstall-Pedoe H, Kuulasmaa K, Amouyel P, Arveiler D, Rajakangas AM, Pajak A. Myocardial infarction and coronary deaths in the World Health Organization MONICA Project. Registration procedures, event rates, and case-fatality rates in 38 populations from 21 countries in four continents. Circulation. 1994;90:583–612.

    Article  CAS  PubMed  Google Scholar 

  25. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150:604–12.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Yano Y, Stamler J, Garside DB, Daviglus ML, Franklin SS, Carnethon MR, et al. Isolated systolic hypertension in young and middle-aged adults and 31-year risk for cardiovascular mortality: the Chicago Heart Association Detection Project in Industry study. J Am Coll Cardiol. 2015;65:327–35.

    Article  PubMed Central  Google Scholar 

  27. Pana TA, Luben RN, Mamas MA, Potter JF, Wareham NJ, Khaw KT, et al. Long term prognostic impact of sex-specific longitudinal changes in blood pressure. The EPIC-Norfolk prospective population cohort study. Eur J Prevent Cardiol. 2022;29:180–91.

    Article  Google Scholar 

  28. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet (Lond, Engl). 2002;360:1903–13.

    Article  Google Scholar 

  29. Peters SA, Huxley RR, Woodward M. Comparison of the sex-specific associations between systolic blood pressure and the risk of cardiovascular disease: a systematic review and meta-analysis of 124 cohort studies, including 1.2 million individuals. Stroke. 2013;44:2394–401.

    Article  PubMed  Google Scholar 

  30. Lau KK, Wong YK, Chan YH, Teo KC, Chan KH, Wai Li LS, et al. Visit-to-visit blood pressure variability as a prognostic marker in patients with cardiovascular and cerebrovascular diseases-relationships and comparisons with vascular markers of atherosclerosis. Atherosclerosis. 2014;235:230–5.

    Article  CAS  Google Scholar 

  31. Zhou TL, Henry RMA, Stehouwer CDA, van Sloten TT, Reesink KD, Kroon AA. Blood pressure variability, arterial stiffness, and arterial remodeling. Hypertension (Dallas, Tex : 1979). 2018;72:1002–10.

    Article  CAS  Google Scholar 

  32. Angeli F, Reboldi G, Verdecchia P. Blood pressure variability and risk of stroke in chronic kidney disease. J Hypertens. 2020;38:599–602.

    Article  CAS  Google Scholar 

  33. Mancia G, Parati G, Hennig M, Flatau B, Omboni S, Glavina F, et al. Relation between blood pressure variability and carotid artery damage in hypertension: baseline data from the European Lacidipine Study on Atherosclerosis (ELSA). J Hypertens. 2001;19:1981–9.

    Article  CAS  Google Scholar 

  34. Kim KI, Lee JH, Chang HJ, Cho YS, Youn TJ, Chung WY, et al. Association between blood pressure variability and inflammatory marker in hypertensive patients. Circ J. 2008;72:293–8.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

We thank all study participants, their relatives, the members of the survey teams at the 11 regional hospitals of the Kailuan Medical Group; and the project development and management teams at the Beijing Tiantan Hospital and the Kailuan Group.

Funding

This work was supported by National Key Research and Development Program of China (2022YFC3600600), Training Fund for Open Projects at Clinical Institutes and Departments of Capital Medical University (CCMU2022ZKYXZ009), Beijing Natural Science Foundation Haidian original innovation joint fund (L222123), and Fund for Young Talents of Beijing Medical Management Center (QML20230505).

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Author notes

  1. These authors contributed equally: Shouling Wu, Xue Tian

Authors and Affiliations

  1. Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China

    Shouling Wu & Shuohua Chen

  2. Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

    Xue Tian, Qin Xu, Yijun Zhang, Xiaoli Zhang, Penglian Wang & Anxin Wang

  3. China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

    Xue Tian, Qin Xu, Yijun Zhang, Xiaoli Zhang, Penglian Wang & Anxin Wang

  4. Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China

    Xue Tian

  5. Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China

    Xue Tian & Anxin Wang

  6. Department of Clinical Epidemiology and Clinical Trial, Capital Medical University, Beijing, China

    Anxin Wang

Authors
  1. Shouling Wu
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Contributions

SW, SC and AW conceived and designed the study. XT, QX, YZ, XZ, PW contributed to the statistical analysis. SW and XT drafted the manuscript. All authors contributed to collecting data and reviewed/edited the manuscript for important intellectual content. All authors read and approved the final manuscript.

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Correspondence to Shuohua Chen or Anxin Wang.

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Wu, S., Tian, X., Xu, Q. et al. Visit-to-visit blood pressure variability and the risk of cardiovascular disease: a prospective cohort analysis. Hypertens Res 46, 2622–2634 (2023). https://doi.org/10.1038/s41440-023-01388-7

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