Long-Term Visit-to-Visit Mean Arterial Pressure Variability and the Risk of Heart Failure and All-Cause Mortality

Liu, Menghui; Chen, Xiaohong; Zhang, Shaozhao; Lin, Yani; Xiong, Zhenyu; Zhong, Xiangbin; Guo, Yang; Sun, Xiaochuan; Zhou, Huimin; Xu, Xin; Wang, Lichun; Liao, Xinxue; Zhuang, Xiaodong

doi:10.3389/fcvm.2021.665117

Cited by 7 publications

(5 citation statements)

References 33 publications

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“…And also there is a long-term visit-to-visit cohort study to explore the association between MAP and all-cause mortality among HF patients. In the study [ 34 ] evaluated 9305 participants, during a median follow-up of 16.8 years, found MAP as a main driving force for vital organ perfusion, was closely related to HF and all-cause mortality. MAP variability was associated with a higher risk of all-cause mortality and HF, indicating that MAP might be a potential risk factor for HF and death.…”

Section: Discussionmentioning

confidence: 99%

Mean arterial pressure and mortality in patients with heart failure: a retrospective analysis of Zigong heart failure database

Ma,

Li,

Sheng

et al. 2023

Blood Pressure Monitoring

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Background It is commonly observed that a higher target of mean arterial pressure (MAP) is in previous studies. This study assessed the association of MAP with short-term mortality in heart failure (HF) patients. Methods A retrospective cohort study was conducted by using data from Hospitalized patients with heart failure: integrating electronic healthcare records and external outcome database(v1.2). The characteristic of patients was described by 3 groups of MAP: below 80 mmHg, 80–100 mmHg, and above 100 mmHg. Univariate and multivariate logistic regression analyses were used to assess the relevance between MAP and all-cause mortality within 28 days and 6 months. For assessing the effect of multiple variables on patient survival time, 28-day and 6-month, Kaplan–Meier survival analysis and Forest plot were performed. Results The overall cohort comprised 2008 patients divided by MAP into 3 groups, each group had 344 (17.1%), 938 (46.7%), and 726 (36.2%) patients. Patients in MAP < 80 mmHg group had higher mortality than MAP 80-100 mmHg and MAP ≥ 100 mmHg in 28 days(3.8% versus 1.6% versus 1.2%) and in 6 months (4.9% versus 2.5% versus 2.3%). Univariate analysis showed that MAP as a continuous variate was associated with 28-day (OR was 0.98, 95% CIs: 0.96–0.99, P = 0.011) and 6-month mortality (OR was 0.98, 95% CIs: 0.97–1, P = 0.021) in HF patients. Model 4 put into multivariate logistic regression analyses showed MAP 80-100 mmHg (OR was 0.13, 95% CIs: 0.02–0.8, P = 0.027) stably associated with 28-day and 6-month mortality after adjusted covariable. Kaplan–Meier survival curves revealed a higher survival rate in the MAP ≥ 80 mmHg group than in the MAP < 80 mmHg group. The forest plot showed the stable effect of MAP ≥ 80 mmHg compared with MAP < 80 mmHg, the interaction analysis had no statistical significance effect between the two groups of MAP and multi-variable. Conclusion It is indicated that MAP was independently associated with 28-day, 6-month all-cause mortality of HF patients, and compared with MAP < 80 mmHg, MAP ≥ 80 mmHg had a lower risk of 28-day, 6-month all-cause mortality of patients with HF.

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Section: Discussionmentioning

confidence: 99%

Mean arterial pressure and mortality in patients with heart failure: a retrospective analysis of Zigong heart failure database

Ma,

Li,

Sheng

et al. 2023

Blood Pressure Monitoring

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“…Historically, BP fluctuations have been perceived as inhibiting accurate BP measurement and as a phenomenon to be overcome by improved monitoring. 10 Recently, ample evidence 11 , 12 , 13 and our previous work 14 both indicated that elevated visit‐to‐visit BP variability could be a new risk factor for CVD. Unfortunately, the contribution of visit‐to‐visit BP variability to the residual cardiovascular risk remains unknown, which impedes the development of an optimum approach to the long‐term reduction of CVD events.…”

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confidence: 94%

Assessment of Visit‐to‐Visit Blood Pressure Variability in Adults With Optimal Blood Pressure: A New Player in the Evaluation of Residual Cardiovascular Risk?

Liu

Chen

Zhang

et al. 2022

JAHA

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Background There is a paucity of evidence regarding the association between visit‐to‐visit blood pressure variability and residual cardiovascular risk. We aimed to provide relevant evidence by determining whether high systolic blood pressure (SBP) variability in the optimal SBP levels still influences the risk of cardiovascular disease. Methods and Results We studied 7065 participants (aged 59.3±5.6 years; 44.3% men; and 82.9% White) in the ARIC (Atherosclerosis Risk in Communities) study with optimal SBP levels from visit 1 to visit 3. Visit‐to‐visit SBP variability was measured by variability independent of the mean in the primary analysis. The primary outcome was the major adverse cardiovascular event (MACE), defined as the first occurrence of all‐cause mortality, coronary heart disease, stroke, and heart failure. During a median follow‐up of 19.6 years, 2691 participants developed MACEs. After multivariable adjustment, the MACE risk was higher by 21% in participants with the highest SBP variability (variability independent of the mean quartile 4) compared with the lowest SBP variability participants (variability independent of the mean quartile 1) (hazard ratio, 1.21; 95% CI, 1.09–1.35). The restricted cubic spline showed that the hazard ratio for MACE was relatively linear, with a higher variability independent of the mean being associated with higher risk. These association were also found in the stratified analyses of participants with or without hypertension. Conclusions In adults with optimal SBP levels, higher visit‐to‐visit SBP variability was significantly associated with a higher risk of MACE regardless of whether they had hypertension. Therefore, it may be necessary to further focus on the visit‐to‐visit SBP variability even at the guideline‐recommended optimal blood pressure levels.

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“…Some studies have shown that BPV predicts cardiovascular events independently of mean blood pressure, 4,5 and that it is a better predictor than the mean blood pressure level 6 . Basson et al 7 demonstrated a correlation between long‐term BPV and the incidence of adverse events, such as death and heart failure, independent of hypertension 8 . However, several studies have indicated no significant association between long‐term BPV and cardiovascular events 9,10 or an increased risk of cardiovascular events is related to long‐term BPV only in patients with hypertension 11 .…”

Section: Introductionmentioning

confidence: 99%

“… 6 Basson et al 7 demonstrated a correlation between long‐term BPV and the incidence of adverse events, such as death and heart failure, independent of hypertension. 8 However, several studies have indicated no significant association between long‐term BPV and cardiovascular events 9 , 10 or an increased risk of cardiovascular events is related to long‐term BPV only in patients with hypertension. 11 Furthermore, a few studies have shown that short‐term BPV may better predict adverse cardiovascular events in young patients with hypertension, as well as mortality in older patients with hypertension.…”

Section: Introductionmentioning

confidence: 99%

Relationship between 24 h blood pressure variability and mortality in acute myocardial infarction patients

Liu,

Li,

et al. 2024

Clinical Cardiology

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BackgroundIn recent years, the mortality of patients with AMI has not declined significantly. The relationship between blood pressure variability (BPV) and acute myocardial infarction (AMI) is unclear. We explored the relationship between 24‐h BPV and mortality in patients with AMI.HypothesisThe mortality of patients with AMI is related to BPV. We hope to provide therapeutic ideas for reducing the risk of death in patients with AMI.MethodsThis is a retrospective cohort study. We extracted and analyzed data from the MIMIC‐IV 2.0, which was established in 1999 under the auspices of the National Institutes of Health (America). The average real variability (ARV) was calculated for the first 24‐h blood pressure measurement after patients with AMI were admitted to the intensive care unit (ICU). Patients were divided into four groups according to ARV quartiles. The outcomes were 30‐day, 1‐year, and 3‐year all‐cause mortalities. Data were analyzed using Cox regression, Kaplan–Meier curves, and restricted cubic spline (RCS) curves.ResultsWe enrolled 1291 patients with AMI, including 475 female. The patients were divided into four groups according to the qualities of diastolic blood pressure (DBP)‐ARV. There were significant differences in the 30‐day, 1‐year and 3‐year mortality among the four groups (p = .02, p < .001, p < .001, respectively). After adjustment for confounding factors, systolic blood pressure (SBP)‐ARV could not predict AMI patient mortality (p > .05), while the highest DBP‐ARV was associated strongly with increased 30‐day mortality (HR: 2.291, 95% CI 1.260‐4.168), 1‐year mortality (HR: 1.933, 95% CI 1.316‐2.840) and 3‐year mortality (HR: 1.743, 95% CI 1.235‐2.461). Kaplan–Meier curves demonstrated that, regardless of SBP or DBP, the long‐term survival probabilities of patients in the highest ARV group were significantly lower than that of those in other groups. RCS curves showed that the death risk of patients with AMI first decreased and then increased with the increase in ARV when DBP‐ARV < 8.04. The 30‐day death risk first increased and then decreased, and the 1‐year and 3‐year death risks increased and then stabilized with ARV increase when DBP‐ARV > 8.04.ConclusionThis study showed that patients with AMI may have an increased risk of short‐ and long‐term death if their DBP‐ARV is higher or lower during the first 24‐h in ICU.

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Long-Term Visit-to-Visit Mean Arterial Pressure Variability and the Risk of Heart Failure and All-Cause Mortality

Cited by 7 publications

References 33 publications

Mean arterial pressure and mortality in patients with heart failure: a retrospective analysis of Zigong heart failure database

Mean arterial pressure and mortality in patients with heart failure: a retrospective analysis of Zigong heart failure database

Assessment of Visit‐to‐Visit Blood Pressure Variability in Adults With Optimal Blood Pressure: A New Player in the Evaluation of Residual Cardiovascular Risk?

Relationship between 24 h blood pressure variability and mortality in acute myocardial infarction patients

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