High Short-Term Blood Pressure Variability Predicts Long-Term Cardiovascular Mortality in Untreated Hypertensives But Not in Normotensives

Hsu, Pai‐Feng; Cheng, Hao‐Min; Wu, Cheng‐Hsueh; Sung, Shih‐Hsien; Chuang, Shao-Yuan; Lakatta, Edward G.; Yin, F. C. P.; Chou, Pesus; Chen, Chen‐Huan

doi:10.1093/ajh/hpw002

Cited by 47 publications

(56 citation statements)

References 26 publications

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“…ARV exhibited the greatest reproducibility during both the observation and treatment periods. In agreement with those results, ARV was a significant predictor in 10 of the 11 studies with a minimum number of BP readings below the average lowest sampling rate …”

Section: Discussionsupporting

confidence: 88%

“…Hsu et al investigated the prognostic value of a high BPV in normotensive and hypertensive subjects over a median follow‐up of 20 years . The results showed that ARV predicted cardiovascular mortality independent of conventional risk factors plus office BP.…”

Section: Resultsmentioning

confidence: 99%

“…Most studies found that ARV was a better estimator of 24‐hour BPV than other measures of dispersion, including SD, CV, and wSD. Of the 19 assessed studies, 17 reported significant associations between high ARV and the presence and progression of subclinical organ damage, as well as the incidence of hard end points, such as cardiovascular events . For all these cases, ARV remained an independent predictor after adjustment for BP and other clinical factors.…”

Section: Discussionmentioning

confidence: 99%

“…Another methodological problem is that the minimum number of valid BP measurements needed to provide a reproducible and reliable assessment of BPV might not have been reached in all studies that use ARV. Mena et al concluded that 48 BP readings during a 24‐hour period is sufficient to compute ARV without meaningful loss of prognostic information . In fact, ARV might be less sensitive to missing readings and low sampling frequency than other BPV indexes.…”

Section: Discussionmentioning

confidence: 99%

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24‐Hour Blood Pressure Variability Assessed by Average Real Variability: A Systematic Review and Meta‐Analysis

Mena¹,

Felix²,

Melgarejo

et al. 2017

JAHA

162

115

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BackgroundAlthough 24‐hour blood pressure (BP) variability (BPV) is predictive of cardiovascular outcomes independent of absolute BP levels, it is not regularly assessed in clinical practice. One possible limitation to routine BPV assessment is the lack of standardized methods for accurately estimating 24‐hour BPV. We conducted a systematic review to assess the predictive power of reported BPV indexes to address appropriate quantification of 24‐hour BPV, including the average real variability (ARV) index.Methods and ResultsStudies chosen for review were those that presented data for 24‐hour BPV in adults from meta‐analysis, longitudinal or cross‐sectional design, and examined BPV in terms of the following issues: (1) methods used to calculate and evaluate ARV; (2) assessment of 24‐hour BPV determined using noninvasive ambulatory BP monitoring; (3) multivariate analysis adjusted for covariates, including some measure of BP; (4) association of 24‐hour BPV with subclinical organ damage; and (5) the predictive value of 24‐hour BPV on target organ damage and rate of cardiovascular events. Of the 19 assessed studies, 17 reported significant associations between high ARV and the presence and progression of subclinical organ damage, as well as the incidence of hard end points, such as cardiovascular events. In all these cases, ARV remained a significant independent predictor (P<0.05) after adjustment for BP and other clinical factors. In addition, increased ARV in systolic BP was associated with risk of all cardiovascular events (hazard ratio, 1.18; 95% confidence interval, 1.09–1.27). Only 2 cross‐sectional studies did not find that high ARV was a significant risk factor.ConclusionsCurrent evidence suggests that ARV index adds significant prognostic information to 24‐hour ambulatory BP monitoring and is a useful approach for studying the clinical value of BPV.

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Section: Discussionsupporting

confidence: 88%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

24‐Hour Blood Pressure Variability Assessed by Average Real Variability: A Systematic Review and Meta‐Analysis

Mena¹,

Felix²,

Melgarejo

et al. 2017

JAHA

162

115

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show abstract

“…There are several studies available showing better prognostic value of ARV in CV risk assessment compared to SD and SBP (16,23).…”

Section: Discussionmentioning

confidence: 99%

Predictors of blood pressure control in patients with resistant hypertension

Pales¹,

Kamenský²,

Payer³

2017

BLL

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BACKGROUND: Uncontrolled resistant hypertension (RH) defi ned by the mean 24-hour ambulatory blood pressure (ABPM) represents an independent risk factor in hypertensive patients. Predictors of blood pressure (BP) control in RH are not yet clearly defi ned. OBJECTIVES: To evaluate the predictors of BP control in RH patients with repeated ABPM measurements. METHODS: 114 consecutive patients from outpatient cardiology offi ce fulfi lling criteria for RH (offi ce BP ≥ 140 and/or 90 mmHg, with treatment of ≥ 3 antihypertensive drugs, including diuretic, or controlled BP with > 3 drugs), with two consecutive ABPM studies were compared in clinical characteristics according to BP control assessed by ABPM RESULTS: After the second ABPM, BP was controlled in 25.4 % of patients; the remaining 74.6 % were classifi ed as uncontrolled. In the uncontrolled BP group, systolic offi ce BP was 140.91±16.71 mmHg, diastolic 81.26 ± 10.92 mmHg. In ABPM, systolic was 145.11 ± 13.65 mmHg, diastolic 81.26 ± 10.92 mmHg. Compared to the controlled BP group, in the uncontrolled group the age was higher 72.32 ±10.89 years (p = 0.047), baseline average real variability of systolic BP was lower 12.66 ± 3.08 vs. 14.52 ± 3.53 (p = 0.013), no signifi cant difference in baseline standard deviation of systolic BP changes was found. CONCLUSION: Higher offi ce BP, older age, and increased short term BP variability were associated with an uncontrolled hypertension. Stronger association was found with baseline average real variability rather than standard deviation. No signifi cant differences were found in the dipping status and other clinical characteristics (Tab. 6, Fig. 1, Ref. 28). Text in PDF www.elis.sk. KEY WORDS: resistant hypertension, ambulatory blood pressure monitoring, blood pressure variability.

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A Bayesian Approach to Modeling Variance of Intensive Longitudinal Biomarker Data as a Predictor of Health Outcomes

Yu,

Wu,

Hicken

et al. 2024

Statistics in Medicine

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Intensive longitudinal biomarker data are increasingly common in scientific studies that seek temporally granular understanding of the role of behavioral and physiological factors in relation to outcomes of interest. Intensive longitudinal biomarker data, such as those obtained from wearable devices, are often obtained at a high frequency typically resulting in several hundred to thousand observations per individual measured over minutes, hours, or days. Often in longitudinal studies, the primary focus is on relating the means of biomarker trajectories to an outcome, and the variances are treated as nuisance parameters, although they may also be informative for the outcomes. In this paper, we propose a Bayesian hierarchical model to jointly model a cross‐sectional outcome and the intensive longitudinal biomarkers. To model the variability of biomarkers and deal with the high intensity of data, we develop subject‐level cubic B‐splines and allow the sharing of information across individuals for both the residual variability and the random effects variability. Then different levels of variability are extracted and incorporated into an outcome submodel for inferential and predictive purposes. We demonstrate the utility of the proposed model via an application involving bio‐monitoring of hertz‐level heart rate information from a study on social stress.

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High Short-Term Blood Pressure Variability Predicts Long-Term Cardiovascular Mortality in Untreated Hypertensives But Not in Normotensives

Abstract: A high short-term BPV is significantly predictive of long-term cardiovascular mortality in untreated hypertensive but not normotensive community-based subjects, independently of office or 24-hour SBP.

Cited by 47 publications

References 26 publications

24‐Hour Blood Pressure Variability Assessed by Average Real Variability: A Systematic Review and Meta‐Analysis

24‐Hour Blood Pressure Variability Assessed by Average Real Variability: A Systematic Review and Meta‐Analysis

Predictors of blood pressure control in patients with resistant hypertension

A Bayesian Approach to Modeling Variance of Intensive Longitudinal Biomarker Data as a Predictor of Health Outcomes

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